Self Referral to Physiotherapy
No Need to See Your GP
This service is only for patients registered at Drayton Practice, Havant Road.
Do you need Physiotherapy?
We are trying a new way for you to get a physiotherapy appointment. Now you do not need to see your doctor before contacting the physiotherapy department. You are able to do this if you are a patient registered at Drayton Practice There is a referral form attached to this leaflet.
What conditions can be treated?
Physiotherapy can help with a range of muscle and joint problems such as:
- Back pain, in the lower or middle back
- Neck pain
- Recent injuries such as strains and sprains.
- Joint or muscle pain.
How to self-refer
You need to complete the self referral form and return it to the Physiotherapy Department at Queen Alexandra Hospital or to Drayton Surgery. You will then need to contact the Physiotherapy Department at QA to make an appointment. This is possible 2 days after receipt of your form.
What can I do to help, in the meantime?
Keeping active
Research has shown that resting for more than a day or so does not help and may actually prolong pain and disability. You may need to modify your activities initially, but the sooner you get back to normal activity the sooner you will feel better.
Getting stiff joints and muscles working can be painful, but this is a normal response and not a sign of damage. Feeling a bit sore initially is also normal and often a good sign that you are making progress.
Changing your position or activity frequently through the day will help to prevent and reduce stiffness. Try to build up your general activity gradually.
Painkillers
‘Over the counter’ painkillers can be helpful. A pharmacist will be able to advise you on the appropriate tablets.
Hot or cold?
If you have an old injury, you may find that holding a hot water bottle wrapped in a towel on the affected area for 10 minutes reduces pain, while for a new injury (hot and swollen joint) you can use a pack of frozen peas wrapped in a damp towel for 10 minutes.
NB: Be aware that hot and cold can burn and that you need to check (every 5 minutes) that your skin does not become very red or blotchy.
Completed forms
Completed forms can either be Faxed to 023 92286552 Posted to Physiotherapy Department, Rehabilitation Building, Queen Alexandra Hospital, Cosham, Portsmouth, PO6 3LY.
Alternatively, give the form to the Surgery Receptionist and they will fax a copy to the Physiotherapy Department.
What to do now?
You need to contact the Physiotherapy department for an appointment. Please do not contact Drayton Surgery.
Please allow 2 working days after submitting your self-referral form.
The appointment line number is 023 92 286845 and is open:
Monday 9am-12pm and 1.30pm-4pm
Tuesday-Friday 10am-12pm and 1.30pm-4pm
What can I expect from Physiotherapy?
You will be seen by a physiotherapist and asked a detailed history of your problem. The affected area will need to be examined and therefore we suggest wearing easily removable clothing.
The findings will be discussed and an appropriate treatment plan will be devised, which may involve advice, exercise and/or manual treatment.
Physiotherapy is a shared undertaking requiring commitment and effort on your part. |
Physiotherapy Self Referral Form
Please complete this form as best you can and return it to the Physiotherapy Department or The Drayton Surgery.
Please then allow TWO WORKING DAYS before contacting the Physiotherapy Department to arrange an appointment.
The appointment line number is 02392 286845 and is open
- Mon 10am-12pm and 1.30pm-4pm
- Tues-Fri 9am-12pm and 1.30pm-4.30pm
Name _________________________________________________________
Address______________________________________________________________________________________________________________________
Contact Number _________________________________________________
GP name _______________________________________________________
GP surgery _____________________________________________________
Date of birth ____________________________________________________
Signed _________________________________________________________
Date __________________________________________________________
In the box below please give a brief description of why you need physiotherapy.
How long have you had this complaint? Is the problem:
New? o Ongoing? o
Are the symptoms worsening?
Yes o No o
Are you able to carry out your normal activities?
Yes o No o
Are you off work because of this problem?
Yes o No o Not applicable o
Are you having difficulty sleeping?
Yes o No o
Since your back pain started have you had difficulties passing or controlling urine?
Yes o No o
If yes, please contact your GP immediately
Have you suddenly lost any weight without trying?
Yes o No o
If yes, please give details. ______________________________________________________________
Have you had any other symptoms, such as numbness, tingling or muscle weakness?
Yes o No o
If yes, please give details. ____________________________________________________________________________________________________________________________