Physiotherapy self-referral

Patients over the age of 16 can self refer to physiotherapy.

Please download the form below and once completed return to us.

Alternatively you can e-mail completed forms to ncm-tr.ncic-imsk-referrals@nhs.net

Please note – incomplete forms may not be processed.

Physiotherapy Self Referral Form (over-16s-only)

Date published: 23rd August, 2024
Date last updated: 23rd August, 2024