Self referral form for Physiotherapy
Physiotherapy can be particularly beneficial if you are suffering from chronic/ongoing low back pain, neck pain, recent injuries such as strains / sprains, or joint and muscular pain.
Unfortunately self-referral is not open to patients with neurological conditions such as Multiple sclerosis, Parkinsons disease, stroke and respiratory conditions. It is important that you do not self-refer without first consulting your GP if you have any of the following conditions - Unexplained weight loss, unexplained bladder or bowel problems, history of cancer, night pain, fever or night sweats, unsteady on feet and pins & needles/numbness in both arms or in both legs.
If you have an acute problem appointments are available via the MSK Team at the Same Day Health Centre - appointments bookable via Lowther Medical Centre Reception.
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key known only to the GP practice and is
accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to
Lowther Medical Centre
1 Castle Meadows, Whitehaven, Cumbria, CA28 7RG.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.