Self-refer into our physio service

For those living in Evesham, Droitwich, Pershore, Malvern, Tenbury, Worcester and Upton. Please click here if you live in Bromsgrove or Redditch

Before you complete the self-referral form

  • Have you read this Physiotherapy Triage Red Flag document?
  • Have you been using the advice and tips on the self-help sections for around 8 weeks? 
  • Are you still feeling pain or discomfort?
  • Are you registered with a GP practice in Evesham, Droitwich, Peshore, Malvern, Tenbury, Worcester and Upton?

If you have answered yes to all the above then you should complete the below form, providing as much information as possible.

Please enter the following information and press submit once. Once submitted you will receive a read receipt and email confirmation. Your Information will now be prioritised by a physiotherapist who may sometimes decide that a telephone assessment is appropriate for your condition you are referring for. You may have to wait some weeks for the assessment depending on how your referral has been classified and current numbers of patients waiting to see the physiotherapist.

You can call 0300 790 0599 Monday - Friday: 8.30am - 16:00 to check the progress of your referral or to cancel an appointment that you no longer require. *Please note that you cannot self-refer by calling this number, please instead complete the self – referral form below.

Personal Details

Note: Questions marked by * are mandatory


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