Refer yourself to Adult Physiotherapy

Criteria for treatment and referral

Please read the following checklist carefully before completing this referral form.

To ensure you are eligible for our service you must meet the following criteria:

• I am over 16 years of age (unless you are referring for hand therapy)
• I am registered with a Gloucestershire GP
• I have read the information about ‘when to seek urgent medical support’ and this does not apply to me
• I am not seeking specific physiotherapy treatment for the following conditions/problems:
  Neurological conditions – e.g. stroke, MS, head or spinal cord injuries, functional neurological disorders or Parkinson’s
  Respiratory conditions – e.g. asthma, cystic fibrosis, chronic lung conditions, hyperventilation
• I do not require community physiotherapy, or physiotherapy at home
• My main problem is not related to mobility or balance issue

If you are a Gloucestershire Health and Care NHS FT member of staff then you can refer yourself to the Staff Physiotherapy Service by using the link under ‘I want to’ on the intranet pages.