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Call 111 if it's less urgent than 999

Physiotherapy Self-Referral

Physiotherapy self-referral is a system which allows you to refer yourself directly to a physiotherapist without having to see a doctor first.

Who can use this self-referral form? 

You can self-refer yourself directly to a Community Physiotherapy Clinic via your GP surgery if:

  • You are18 years old or over.
  • You have any injuries or conditions affecting the joints, muscles and tendons.
  • You are experiencing back or neck pain.
  • You are experiencing other musculoskeletal (MSK) upper or lower limb joint problems.
  • You have a sports injury.

Which patients/conditions are NOT accepted via self-referral?

  • If you are under 18 years of age.
  • If you have weakness, stiffness and/or poor mobility due to any neurological condition including stroke, Parkinson’s disease, Multiple sclerosis etc.
  • Flare up of inflammatory rheumatological conditions such as Rheumatoid Arthritis – you need to access treatment in secondary care at the hospital.
  • Widespread joint pain or chronic pain (where this is the primary reason in absence of specific MSK joint problems) – please speak to your GP about other appropriate services.
  • If you are in need of mobility aids such as a walking stick, crutches, frames etc. You need to complete a social care for adults online contact form.
  • If you are pregnant with back pain in the 3 months before or after delivery. You will need to attend St Marys Hospital and can self-refer directly by calling 0161 276 6411.

If your referral is not appropriate for physiotherapy treatment it will be rejected and sent back to your GP and you will be notified by your GP practice. 

Can I refer for multiple problems?

We request that you refer for just one condition per referral.  This is to keep waiting times down and improve the quality of your care. Once a physiotherapist has completed care for this condition you may then refer again for something else if necessary.

How does it work? 

Please complete the form. It is important that you complete the form fully, making sure your address and contact details are up to date and giving as much information as possible regarding your condition. Any missing information may result in a delay in you being seen.

What happens next? 

Your GP surgery will check your referral before forwarding this to the community physiotherapy team. You will then be added to our waiting list. Once you are at the front of the waiting list the physiotherapy department will book you an appointment and notify you by letter and text message. 

Please Note - Community Physiotherapy Clinics are based within Community Health Centres and not at the Hospital.

 

About You
You can find your NHS number at https://www.nhs.uk/nhs-services/online-services/find-nhs-number/
Please describe your ethnicity
About Your Problem
We will only see you for one problem. If you have more than one problem please put it on a separate referral.
For example scans, x-rays or blood tests.
About Your Current Symptoms
For example, inability to urinate or pass stools or incontinence of urine or faeces. If yes, please give details.
If yes, please give details.
If yes, please give details.
If yes, please give details.
Confirmation
Please type your name as confirmation.

GP Practice

Levenshulme Medical Practice

Levenshulme Health Centre

Dunstable Street

Levenshulme

M19 3BX


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Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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Levenshulme Medical Practice

Dunstable Street, Levenshulme, Manchester, M19 3BX

  • 0161 225 4033
  • gmicb-mh.levenshulme@nhs.net
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