Physiotherapy Self Referral

  • Physiotherapy Self Referral

    Please answer these initial screening questions

  • Please Note: We no longer take Hull referrals here. Please use our Self‑Referral page to access the Hull service.

  • Are you contacting us regarding a lump or bump?*
  • Are you contacting us regarding a problem related to a previous surgery?*
  • Does your condition relate to recent trauma (e.g. a fall), that means you are unable to fully weightbear?*
  • Does your condition have any of the following symptoms? A fever and/or red hot swollen joint(s)?*
  • Before we start to find out about your back or widespread pain issue, we need to make sure that this referral route is the best for you. There are a few very rare, but serious conditions that can occur that need a much faster response than can be given via this route.

  • Physiotherapy Self Referral

    Now tell us about your problem

  • Physiotherapy Self Referral

    Finally, tell us who the referral is for.
  • Date of Birth*
     - -

  • Find your NHS Number here

  • Do you require a language interpreter?*
  • Do you have communication or learning difficulties or need reasonable adjustments for your appointments?*
  • Are you off work due to this problem?*
  • Does your pain affect your ability to care for a dependant?*

  • By submitting the self-referral form you are consenting to Cora Health using your data appropriately.

    Press Submit below to complete your referral

  • For more details about how we use your data, please see here

  • Please call NHS 111 for further advice as these symptoms are signs of infection.

    A referral from your GP is required if your symptoms persist.

  • Unfortunately we are unable to accept a self referral on this occasion. 

    A direct referral from your GP will be required with additional supporting information to ensure you are seen by the right service.

  • Back pain in combination with these symptoms could be a sign of something more serious. 

    These symptoms need checking. You should contact NHS 111 immediately for further assessment. If you have already seen your GP about this issue and they think it is okay for you to have physiotherapy, then we will need a referral directly from them stating that they are aware of these symptoms, but they are not to be worried about.
  • Should be Empty: