Note to patients:
The leaflet below is as it was supplied from Western Sussex
Hospitals NHS Trust. Unfortunately has some errors and you will
note:
The link in option 3 – last time we checked (18 August 2014)
took you to a web page with no sign of an online form. When /
if they do get this working you should make sure your browser
shows it is a secure link and connects via https to ensure your
details are confidential.
We suggest you use this leaflet simply as an outline of the service
they offer and you then telephone the appropriate number.
Worthing Medical Group
August 2014
PHYSIOTHERAPY SELF REFERRAL
What happens once you have contacted us?
Once we have your details, we will contact you and discuss your
problem with you. At the end of the telephone consultation, we will
decide what type of treatment is best for you. This might be:

Advice on how to manage your problem

Advice and a home exercise programme sent to you by post
or email

Advice to see your GP if we think the problem is not suitable
for physiotherapy.

You may be given an appointment for face to face treatment
in the physiotherapy department which is most convenient
for you.
We hope that this service will help people to access physiotherapy in
a more convenient way, so that they can get their treatment started at
the right time, and get better more quickly.
This service is for people who are over 18 with musculoskeletal
problems, such as muscle and joint pain, sports injuries back or neck
pain, sprains and strains.
You can still see your GP and be referred to us in the usual way, or
you can refer yourself. If you are under 18, please speak to your GP,
and they can refer you to us if appropriate
How do you refer yourself to physio?
1 By filling in this form and sending it to us or dropping it in to us
at:
 Worthing Hospital, Lyndhurst Rd, Worthing BN11 2DH

Southlands Hospital, Old Shoreham Rd, Shoreham-by-Sea
BN43 6TQ

Littlehampton Health Centre, Fitzalan Rd, Littlehampton
BN17 5HG
2 By calling Physio Direct on:
 Worthing area: 01903 285298

Southlands area: 01273 446004

Littlehampton area: 01903 843630
3 By completing the online self-referral form which can be found
at: http://www.westernsussexhospitals.nhs.uk/departments/physiotherapy
PHYSIOTHERAPY SELF REFERRAL FORM
About you
Your name:__________________________ Date of birth:________________
Daytime telephone no:_________________ Mobile no:__________________
Email address: ___________________________________________________
Are you happy for us to leave an answerphone message? YES
NO
Address:
Postcode:
Preferred contact time: AM early- AM late- PM early- PM late (please circle)
GP: ______________________________Surgery: _______________________
About your problem
What part of your body is affected by your problem?
We will contact you by telephone or email to arrange further treatment.
This may be in the form of advice, advice and exercise, or a face to face appointment,
depending on what is best for your problem. If we cannot get hold of you by
phone/email we will send you a letter to arrange an assessment