Physiotherapy Self-Referral

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1. Physiotherapy Self-Referral

Completing your physiotherapy referral will take around 20 minutes. It is important you provide information which is as accurate as possible to ensure you are offered the correct service to help your condition. Some questions are mandatory as indicated by a * next to the question.

To complete this form you will need:

Your NHS number (you can find out your NHS number by using this website https://www.nhs.uk/nhs-services/online-services/find-nhs-number or by finding it on your prescription sheet or any G.P/Hospital letters you have received)
Your previous medical history
Your current medication

By completing this form you consent to Sussex MSK Partnership East sharing the information provided with your G.P and our physiotherapy providers.

The information that you submit on this form will be reviewed by one of our Physiotherapists as part of your physiotherapy assessment.

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