Sussex MSK Partnership Self-Referral
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1. Important Notice

 
Important notice about coronavirus (COVID-19)

Due to these unprecedented times the safety of our patients and staff is our chief concern. 

Following national guidance, we have suspended our normal service to enable our staff to be made available for redeployment into other areas of the NHS, but are continuing to provide only an essential service for those patients who require clinical management.

Please use this referral form if you think you meet the criteria below, otherwise please use our website information to self manage your condition until the coronavirus (COVID-19) risk has passed. You will be contacted by telephone in the first instance by a clinician who will assess your needs and agree the way forward with you.

You can familiarise yourself with the symptoms and risk factors for coronavirus (COVID-19) on the NHS website and on the Government’s information page for coronavirus (COVID-19). If you are concerned contact NHS 111 who will advise you what to do next. 

Reasons to refer yourself to our service at the moment: 
  • ​Recent Orthopaedic Surgery
  • Recent significant injury (e.g. fall)
  • New symptoms such as pins and needles, numbness and/or associated weakness
  • New severe spinal pain at night, waking you for considerable periods
  • Back pain or pelvic pain associated with pregnancy
  • If you are highly concerned about your condition
  • If you have been redirected to us by your GP
Important notice

 

Do not complete this form and call NHS 111 
If you have recently or suddenly developed the following with the onset of your lower back pain and / or leg pain:
  • A change in your bladder function or bowel control.
  • Altered sensation around your genitals or back passage.
  • Loss of sexual function​.

Do not complete this form but make an appointment to see your GP to discuss your referral
If you have any of the following:
  • Any unexplained weight loss.
  • Are feeling generally unwell / feverish.
  • Have recently become unsteady on your feet.

Please do not continue with this form and instead make an appointment to see your GP if you are under 16 years of age.

1. Are you the patient, or are you completing the form on behalf of a patient? *