Refer yourself to Adult Physiotherapy

Criteria for treatment and referral

Please read the following checklist carefully before completing this referral form.

To ensure you are eligible for our service you must meet the following criteria:

• I am over 16 years of age (unless you are referring for hand therapy)
• I am registered with a Gloucestershire GP
• I have read the information about ‘when to seek immediate medical assessment’ and this does not apply to me
• I am not seeking specific physiotherapy treatment for the following conditions/problems:
  Neurological conditions – e.g. stroke, MS, head or spinal cord injuries, functional neurological disorders or Parkinson’s
  Respiratory conditions – e.g. asthma, cystic fibrosis, chronic lung conditions, hyperventilation
• I do not require community physiotherapy, or physiotherapy at home
• My main problem is not related to mobility or balance issues