Physiotherapy Self-Referral Form

If you have a back, neck, joint or general muscle problem you can self-refer using this form.

Physiotherapy Self-Referral Form

Once you have completed the form please send to: 

Email: (Please note we prefer to receive referrals via email)

Physiotherapy Central Bookings Office
Bognor Regis War Memorial Hospital
Physiotherapy Department
Shripney Road
Bognor Regis PO22 9PP

What will happen to my referral once I have sent it?

A qualified Physiotherapist will review your referral within 2 working days of it arriving in the department. You will then be sent an acknowledgement letter to confirm we have received your referral.  It is, therefore, very important that you complete all information as fully as possible in order for the team to safely and effectively manage your referral. If there is insufficient information on the form it may be returned to you and this could delay your treatment.

The length of time you wait for an appointment may vary according to clinical need. When an appointment becomes available the administration team will contact you to arrange an appointment, either by post or telephone.

What happens if I am not appropriate for this service.

When a physiotherapist reviews the referral they may identify that your treatment would be better managed by another team/service. In this instance your referral would be directed on to the appropriate service.


Back to Physiotherapy (Coastal Musculoskeletal Outpatient)