WELLS NHS TRUST
INFORMATION FOR PATIENTS ABOUT THE PHYSIOTHERAPY SELF-REFERRAL SERVICE
WHAT IS SELF-REFERRAL?
A service has been set up to provide direct access to Outpatient Physiotherapy for adults with back, neck or joint problems, or following injury.
HOW DO I ACCESS THE SERVICE?
Please print and complete the self-referral form below. It is important to fill out the form as fully as possible. Take or send the form to the Outpatient Physiotherapy Department at one of the hospitals listed.
WHAT WILL HAPPEN NEXT?
Your form will be processed by a Physiotherapist. You will then be contacted based on the information you have supplied.
WHAT CAN I DO TO HELP MYSELF IN THE MEANTIME?
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 doing them normally 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 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.
‘Over the counter’ painkillers can be helpful. A pharmacist will be able to advise you on the appropriate tablets. If your symptoms continue to worsen you are advised to see your GP
HOT OR COLD
Some people find that a hot water bottle wrapped in a towel on the affected area for 10minutes can reduce pain, whilst others prefer using a pack of frozen peas wrapped in a damp towel for 10minutes.
N.B. Be aware that hot and cold can burn and that you need to check (every 5minutes) that your skin does not become very red or blotchy; if this happens stop use.
OUTPATIENT PHYSIOTHERAPY DEPARTMENTS WHICH WILL ACCEPT YOUR PHYSIOTHERAPY SELF-REFERRAL FORM
ME16 9QQ TN18 4PU
Tel: 01622 224300 Tel: 01580 753412
Fax: 01622 224561 Fax: 01580 752668
Churchill Centre Outpatients Physio
Preston Hall Coxheath Clinic
Tel: 01622 225722 Tel: 01622 741860
Fax: 01622 225725 Fax: 01622 749179
ADDRESS: TELEPHONE NUMBERS
Please tick as appropriate:
When did this problem start? Less than 2 weeks, 2-6 weeks, 4-6 weeks, 6-12 weeks, more than 12 weeks?
Is the problem;
new? □ ongoing? □
getting better?□ getting worse? □ staying the same? □
Does it wake you at night? Yes □ No □
Is the problem stopping you from working? Yes □ No □
Is there anything the problem is stopping you doing? Yes □ No □
If you have pain please indicate how severe your pain is on this line on a scale of 0—10.:
0 1 2 3 4 5 6 7 8 9 10
Please tick as appropriate
Have you consulted your GP about this problem? Yes □ No □
Have you tried anything to help with your problem? (e.g. pain killers, exercise, other treatment)
Yes □ No □
Have you had Physiotherapy for the same problem in the last 6 months? Yes □ No □
If so where did you have your physiotherapy?
Please take your completed referral form or send it to your nearest Out-patient Physiotherapy Department:
If you have any queries please contact :
Coxheath Clinic 01622 741860