Physiotherapy Self-Referral Brighton & Hove
If you have recently or suddenly developed the following with the onset of your lower back pain and / or leg pain:
Do not complete this form and make an Urgent appointment to see your GP or call NHS 111.
- A change in your bladder function or bowel control.
- Altered sensation around your genitals or back passage.
- Loss of sexual function.
If you any of the following:
Do not continue with this form but make an appointment with your GP to discuss this referral.
- 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.
- Unable to attend the Outpatient Department. If you believe you need domiciliary physio (physiotherapy at home).
- Seeking treatment for Neurological or respiratory disorders.