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Welcome to the MSK Physiotherapy Self-Referral Form

Call 999 or go to A&E immediately if:

Since your symptoms started, you have had any of the following: 

  • bladder problems, such as accidents or difficulty starting or stopping your flow of urine
  • bowel problems, such as accidents or leaking
  • changes in sexual function or sensation
  • numbness or tingling around the genitals or back passage
  • numbness or tingling in both legs

In rare circumstances these symptoms can be caused by a serious condition called Cauda Equina Syndrome, and needs urgent attention.

If you have any of these symptoms, you will not be able to self-refer to MSK Physiotherapy.

Find your nearest A&E

If none of these apply to you, please continue by following the instructions below

​​​​​​ Submitting a referral is a 3 step process, and usually takes around 15 minutes to complete

  • ​​Step 1: Eligibility (Checking whether this is the right service for your needs)
  • ​​Step 2: Personal details
  • ​​Step 3: Additional questions about your symptoms

​​The following information is required to complete your referral. You will not be able to submit the referral without it.

  • Your NHS number
  • Your address and postcode
  • Your date of birth
  • Your email address
  • Your phone number

​​​​​​ Finding your NHS number

You can find your NHS number in one of the following ways:

  • On the NHS App
  • On letters or communications from your GP, hospitals, or us
  • Use the NHS "Find Your NHS Number" service. This link will open in a new window. You’ll need your full name, date of birth, and postcode. Your NHS number will be sent to you immediately by text or email.

Click 'Next' to start your self-referral.

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