Physiotherapy Self Referral Form

The Royal Orthopaedic Hospital Physiotherapy team are specialists in treating musculoskeletal and orthopaedic conditions. These are issues that affect the bones, joints, muscles and nerves.

Please note we are unable to accept self referrals for the following conditions:

• Home visits
• Respiratory conditions (e.g. Asthma, Cystic Fibrosis)
• Neurological conditions (e.g. Stroke, Multiple Sclerosis, head injury)
• Non-musculoskeletal pain
• Long COVID
• Pelvic health conditions (e.g. Incontinence)

If you need help with any of the above, please speak to your GP, who can guide you to the most appropriate service.

How to refer yourself:

Please click continue and complete the form giving as much information as possible. The more we understand about your symptoms, the better we can support you. Any missing information may result in a delay in you being seen. The form usually takes around 5-8 minutes to complete.

Before completing the self referral form please ensure you have a list of your current medications and have your NHS number (10 digit number). If you do not know your NHS number please click here to be directed the website to find your NHS number.

If you are unable to complete the online referral please contact the physiotherapy team on 0121 812 3500 for support on how to self refer. The phone lines are open Monday to Friday 08:30 until 16:30.