Self Referral Form
You can refer yourself to access NHS Physiotherapy services through Ann Physiocare
Please read the below ‘Guidance and Information’ carefully and proceed to self refer if your answer is ‘No’ to all the below
Are you under 16
*Do you require emergency treatment (immediate, serious and life threatening)
*Do you require treatment in your own home
*Do you require treatment for Respiratory condition?
*Do you require treatment for Neurological condition?
*Do you require treatment for Post amputation
*Do you have Difficulty passing urine or controlling bladder/bowels
*Do you have Numbness or tingling around the back passage or genitals
*Do you have Numbness, pins and needles or weakness in both legs.
*Are feeling generally unwell or have a fever
*Have any unexplained weight loss
*Have a history of cancer
*Have recently become unsteady on your feet.
*Patients who require emergency treatment (immediate, serious and life threatening, Please contact 999 or consult NHS 111 or your GP
*Please contact and Discuss with your GP if you have answered ‘Yes’ to any of the aboveIf you have answered ‘No’ to all the above questions,
*Please continue to self refer