Musculoskeletal Therapy Services (MSK) Self-Referral

Please use the form below to complete a Musculoskeletal Therapy Services Self-Referral.

Contact NHS 111 urgently if you have recently developed:

  • Difficulty passing or unable to pass urine
  • Loss of bowel control
  • Unstable when walking/feet do not go where you want them to
  • Numbness or tingling around your back passage or genitals
  • Loss of sexual function, unable to achieve and maintain an
    erection, lack of sensation during sexual intercourse

Please see your GP initially if you have:

  • Existing diagnosis of Cancer
  • Severe Low Back Pain with night sweats, fever, sickness
  • Unexplained weight loss
  • Severe constant night pain
  • Severe pain with history of fatigue
  • Hot or swollen joints
  • Generally unwell
  • A problem that is effecting more than one body part

If you are aged 16 or under, please do not complete. Contact your GP to talk about your condition.