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Refer yourself

The self referral form is currently open to patients who are registered with a Vale of York CCG or East Riding GP practice.

Self referral is open to anyone over the age of 17 with a musculoskeletal pain problem. Please see our conditions directory for the types of conditions we treat.

Self referral is not available for other types of physiotherapy (e.g. women's health, neurology, respiratory, community/ mobility problems). If you think you need a referral to one of these services please speak to your GP.

A PDF copy for Vale of York GP Practices to print is available here.

Self referral form

Welcome to the self referral section of our website. While self referral to physiotherapy is appropriate for the majority of people, there are some exceptions where we would ask that you see a Doctor first.

  1. If you have a significant past medical history of cancer, or are currently undergoing treatment for cancer you should make an appointment to see your GP to discuss a physiotherapy referral.
  2. If you are experiencing back pain AND have any of the following symptoms: •tingling or numbness between your legs and around your buttocks •recent loss of bladder or bowel control, or both

You should IMMEDIATELY attend the Emergency Department of your local hospital.

Although it's rare, these symptoms can be a sign of a serious condition called cauda equina syndrome.

To proceed with the physiotherapy self referral system tick the box below