Gloucestershire Podiatry Referral Form


Please read the following carefully before completing this referral form.

The Podiatry Service is a specialist clinical service which provides highly specialist podiatric care for patients with significant foot complications.

The Podiatry Service provides access for patients who require the following podiatric interventions:

  • High/Moderate Risk patients (foot health at significant risk of ulceration / amputation) requiring highly specialist podiatric interventions
  • Wound care issues; i.e. diabetic foot ulcers, specialist wound care skills of debridement and offloading casting devices
  • In-growing toe nail surgery
  • High/Moderate Risk diabetic foot screening – please note low risk diabetic foot screening is available from GP Practice
  • People with peripheral arterial disease and foot pathology
  • Painful musculoskeletal foot problems in children and adults
  • Severe foot deformities that may require surgery

Please Note: All first appointments will be a remote assessment either by telephone or video call. Face to face appointments will only be offered if needed following an initial assessment.

The Podiatry Service is unable to accept referrals for:

  • Toe nail cutting (all patients)
  • Verrucae
  • Fungal nail infections, fungal skin infections and other dermatological skin conditions
  • Footwear related corns/callus
  • Foot deformities with no pain and/or minimal risk of wounds or infection
  • Minimal or non-painful corns
  • Adult MSK conditions that cause mild pain but is not affecting the ability to work

Patients must be registered with a Gloucestershire GP Practice to access Gloucestershire Health and Care Podiatry Service.

Patients requiring general routine Podiatry care who do not fulfill the criteria for treatment will be required to seek non-NHS Podiatry Services, i.e. HCPC registered Podiatrists.

Home visits
Please be aware our Podiatry team is only able to offer domiciliary (home) visits for bed-bound patients who need specialist transport to enable them to attend a visit. Referrals for this service can only be made by registered healthcare professionals such as GP’s, nurses and other qualified staff. 

What happens to the referral form?

  • The referral form must be completed in full with as much detail as possible and sent to
  • The referral form will be triaged according to clinical priority based on referral form information.
  • The referral form will be rejected in cases where insufficient information is provided.
  • The patient will receive notification of their virtual appointment if accepted.
  • It is important that the patient or their carer informs the Podiatry Service if they no longer require the appointment or unable to attend as we can offer the appointment to another patient.

What happens at the assessment appointment?

  • The patient will be assessed, if necessary a face to face appointment will be offered. All patients will be directed to self-management videos and advice on the Podiatry website.
  • A treatment plan will be developed for those patients requiring treatment.
  • The patient will be discharged from the Podiatry Service if the patient does not fulfil the Podiatry Service criteria. Advice and health education will be given.