Please complete the form below fully and give as much information as possible. Any missing information may result in a delay in you being seen.
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 728 9442 for support on how to self refer. The phone lines are open Monday to Friday 08:30 until 16:30.