Physiotherapy form

Musculoskeletal Physiotherapy Referral Form

Please complete all of the details in the form below and on submission this will be sent directly to our booking office team where your referral will be uploaded to the system for triage.

Please allow five working days from submission before contacting the booking office to book your appointment.  

In order to book your initial appointment, please either call our booking office on 0300 373 0212 or 
e-mail: physioenquiries@southernhealth.nhs.uk (emails aim to be responded to within two working days)

Please ensure you check your Junk folder for emails as depending on your mailbox settings, responses may end up here.  

For more details about the service, how to book your appointment and self-managment advice, please download our information sheet here.

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Please consult NHS 111 or your GP urgently if you have recently or suddenly developed:
•    Difficulty passing urine or controlling bladder/bowels.
•    Numbness or tingling around your back passage or genitals.
•    Numbness, pins and needles or weakness in both legs.

Please discuss with your GP before submitting this referral if you:
•    Are feeling generally unwell/fever
•    Have any unexplained weight loss
•    Have a history of cancer
•    Have recently become unsteady on your feet
 

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Patient information

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Europe/London
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Your address
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If you dont know your NHS number you can find it here 

Next of Kin details

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Please describe your current problem and symptoms below

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