Regardless of your recent travel history if you have recently developed a cough or fever please do not attend your appointment. You can familiarise yourself with the symptoms and risk factors for Coronavirus on the NHS website and on the Government's information page for Coronavirus. If you are concerned contact NHS 111 who will advise you what to do next.


Do not complete this form and call NHS 111
If you have recently or suddenly developed the following with the onset of 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.
• Are unable to attend the Outpatient Department. If you believe you need domiciliary physio (physiotherapy at home).
• Are seeking treatment for Neurological or respiratory disorders or a diagnosed rheumatological condition. 

We request you do not self-refer within the first 6 weeks of developing a new condition.

This is because 86 out of 100 people who develop ‘new’ symptoms e.g. shoulder pain get better within 6 weeks. If your symptoms are less than 6 weeks' old you may be able to self-manage with simple advice and exercise.

Please visit our website www.sussexmskpartnershipcentral.co.uk/self-care/ for up-to-date information that may help you to manage your symptoms.

However, if you are concerned or your condition is worsening please contact your GP or phone NHS 111.

Your NHS Number

Before you start, please ensure that you have your NHS Number at hand. Please note that we will not be able to process your referral without it.

You can use this online service to find your NHS Number: https://www.nhs.uk/nhs-services/online-services/find-nhs-number/

Alternatively, you should be able to find your NHS Number on any letter or document you have received from the NHS, including prescriptions, test results, and hospital referral or appointment letters. Each NHS Number is made up of 10 digits shown in a 3-3-4 format (e.g. 000-000-0000). If you cannot find your NHS Number at home, you can ask your GP practice to help you. They should be able to provide the number for you as long as you are registered with them.

For more information on how to find your NHS Number please click here.