Refer Yourself

You can refer yourself to Healthshare Hull MSK Physiotherapy/Podiatry service if you:

  • have already tried physical therapy yourself (see guidance and exercises by clicking the links above)
  • have an MSK related issue/condition
  • are registered with a Hull GP
  • are over 18 years old
  • are not under the care of a hospital consultant for the same problem

You need to see your GP for a referral to us if you:

  • need Orthopaedic, Neurosurgical or MSK Rheumatological input
  • are aged between 1 and 18 years
  • require post stroke rehabilitation
  • require home visits

HELP WITH TRAVEL COSTS……
If you are referred to hospital or other NHS premises for NHS specialist treatment or diagnostic tests by your doctor, dentist or other health professional, you may be able to claim a refund of reasonable travel costs under the Healthcare Travel Costs Scheme (HTCS).  
Visit the NHS UK website to find out who is eligible for the scheme and how to make a claim.
HCT(T) Refund claim form - travel costs to receive NHS treatment.

By filling out this form and submitting it you consent to data being transferred via secure email.
We would be grateful if you could have your NHS number ready when contacting us or using this self-refer page.

 Please ensure you fill out all mandatory fields marked with an asterisk(*).
When you click the Submit button at the end of the form and it does not appear to work please check that you have completed the required fields.  When submitted successfully you should receive a completion message.

DEMOGRAPHIC INFORMATION

Please select an option

Please state in what capacity you know the patient

Please select

Briefly explain what you have tried

Please select

Please tick those that apply

Please enter your first name

Please enter your surname

YOU MUST BE 18 OR OVER TO SELF-REFER
Date of birth*
Please enter your date of birth

**Please use the format DD/MM/YYYY**

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Please complete

Please select a number

Please enter your address

Please enter your address

Please enter your county

Please enter your post code

Please enter a valid email address

If you have provided an email address confirmation of your self-referral will be sent to you when you have successfully submitted the form.
Please check the spam folders within your email if you do not receive a confirmation in your inbox.

Please select an option

Please tick one of the options

Please enter your landline number

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Please enter your mobile number

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If ticking email please enter your email address in the 'Email Address' box above

Please enter a GP name

Please enter the name of your GP surgery

GP surgery telephone number (if known)

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Please enter your NHS number

Please select either lbs or kg

Please select your height from the dropdown menu

Please adjust the slider to your weight in kilograms

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Please type your ethnicity in the box

Please enter ethnicity


CURRENT DIFFICULTIES
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Please tell us how long you've had this complaint

Please briefly explain why you need physiotherapy

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Please tick all that apply

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Some of the symptoms you have indicated may need more urgent care.
We do not think self-referral is suitable for you.
Please consult your GP or NHS 111 urgently.

You will not be able to submit the self-referral.

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Please give details


Some of the symptoms you have indicated may need a GP consultation.
We recommend that you discuss these with your GP prior to making a self-referral.

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Under each heading, please tick the ONE box that best describes your health TODAY

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If you click the Submit button and nothing appears to happen please check that you have filled out all the mandatory fields.

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