Physiotherapy self referral

Use this service to refer yourself directly to a physiotherapist without having to see a doctor first.

You can use this service if you:

• are registered at the surgery

Before you start

Please read our community musculoskeletal (MSK) physiotherapy self referral information page for more information about whether this is right for you and how it works before filling in the form.

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of

Start now