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SelfReferral for Routine Adult Outpatient Physiotherapy (over 16 years of age) IMPORTANT This form must be completed in full or an appointment may be delayed Name:Mr/Mrs/Miss/Misaddress:Date of Birth: Date
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How to fill out self-referral for routine physiotherapy

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How to fill out self-referral for routine physiotherapy

01
To fill out a self-referral for routine physiotherapy, follow these steps:
02
Obtain the self-referral form from your physiotherapy clinic or download it from their website if available.
03
Fill in your personal details such as your name, address, contact information, and date of birth.
04
Provide information about your current health condition or the reason for seeking physiotherapy.
05
Indicate the type of physiotherapy service you require (e.g., assessment, treatment, rehabilitation).
06
If you have any relevant medical history or previous treatments, provide this information on the form.
07
Specify your preferred physiotherapy clinic or practitioner, if applicable.
08
Sign and date the self-referral form.
09
Submit the completed form to the physiotherapy clinic either in person, by mail, or through their online submission system.
10
Wait for the clinic to contact you to schedule an appointment or further discuss your physiotherapy needs.

Who needs self-referral for routine physiotherapy?

01
Anyone who requires routine physiotherapy can make use of a self-referral. This may include individuals with mild musculoskeletal injuries, individuals seeking preventive physiotherapy, or those with chronic conditions requiring ongoing physiotherapy. It is always recommended to consult with your healthcare provider or physiotherapist to determine if self-referral is suitable for your specific needs.
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Self-referral for routine physiotherapy is a process that allows individuals to initiate their own treatment by contacting a physiotherapist directly, without needing a referral from a physician.
Typically, individuals seeking physiotherapy services for their conditions are required to file a self-referral. This may include patients with musculoskeletal issues, post-surgery rehabilitation needs, or chronic pain.
To fill out a self-referral for routine physiotherapy, you typically need to complete a form that includes personal information such as your name, contact details, medical history, the reason for referral, and any specific treatments you are seeking.
The purpose of self-referral for routine physiotherapy is to empower patients to take charge of their healthcare, allowing them to seek treatment for musculoskeletal issues promptly and potentially reducing waiting times for physiotherapy services.
The information that must be reported on self-referral includes personal identification details, description of the injury or condition, previous treatments, duration of symptoms, and any relevant medical history.
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