Get the free Continence/Pelvic Floor Physiotherapy Referral Form

MELBOURNE COLORECTAL SPECIALISTS PELVIC FLOOR INVESTIGATION REFERRAL FORM: INDIANA ULTRASOUND & ANAL MANOMETRY PATIENT INFORMATION number: First name: Phone: Address:Date of Birth: Surname: email:REFERRING

How to fill out continencepelvic floor physioformrapy referral

How to fill out continencepelvic floor physioformrapy referral

1. To fill out a continence/pelvic floor physiotherapy referral form, follow these steps:
2. Begin by providing your personal information, such as your full name, address, and contact details.
3. Indicate whether you are a new patient or if you have been previously seen by a continence/pelvic floor physiotherapist.
4. Specify the reason for seeking continence/pelvic floor physiotherapy.
5. Provide any relevant medical history, including past surgeries or conditions related to continence or pelvic floor issues.
6. Mention any medications or treatments you are currently undergoing for your condition.
7. If you have been referred by a healthcare professional, include their name, contact details, and the reason for the referral.
8. Finally, sign and date the referral form.
9. Make sure to submit the filled-out referral form to the appropriate healthcare provider or clinic.

Who needs continencepelvic floor physioformrapy referral?

1. Individuals who may benefit from a continence/pelvic floor physiotherapy referral include:
2. - Those experiencing urinary incontinence, fecal incontinence, or pelvic organ prolapse.
3. - Women who have recently given birth and are experiencing issues with their pelvic floor muscles.
4. - Individuals with pelvic pain or discomfort, especially if related to the pelvic floor.
5. - Post-surgical patients who require rehabilitation or support for continence or pelvic floor function.
6. - Those with a history of prostate surgery or radiation therapy for prostate cancer.
7. - Individuals with neurologic conditions that may affect bladder or bowel control, such as multiple sclerosis or spinal cord injury.
8. It is always best to consult with a healthcare professional to determine if a continence/pelvic floor physiotherapy referral is appropriate for your specific condition.

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What is continence/pelvic floor physiotherapy referral?

Continence/pelvic floor physiotherapy referral is a referral to a specialized physiotherapist who treats issues related to pelvic floor dysfunction, such as incontinence or pelvic pain.

Who is required to file continence/pelvic floor physiotherapy referral?

Healthcare providers, such as doctors or nurse practitioners, are typically required to file continence/pelvic floor physiotherapy referrals for their patients.

How to fill out continence/pelvic floor physiotherapy referral?

To fill out a continence/pelvic floor physiotherapy referral, healthcare providers need to include relevant patient information, reason for referral, and any relevant medical history.

What is the purpose of continence/pelvic floor physiotherapy referral?

The purpose of continence/pelvic floor physiotherapy referral is to connect patients with specialized physiotherapists who can help them address pelvic floor dysfunction issues.

What information must be reported on continence/pelvic floor physiotherapy referral?

Information such as patient demographics, reason for referral, relevant medical history, and any other pertinent details should be reported on continence/pelvic floor physiotherapy referral.