Self-referral Form

Self-Referral Form

Prior to completing this self-referral form please be advised that:

We can only accept self-referrals from patients (16 years or older) living within the Plymouth, kingsbridge or Tavistock catchment area, who are registered with a Plymouth, Kingsbridge or Tavistock GP.
You must be seeking help with a Musculoskeletal problem, such as neck or back pain or soft tissue or joint problems such as strains and sprains.Find further guidance about physiotherapy self-referral.
It is important you do not self-refer if you have any of the following conditions without consulting your GP
Unexplained weight loss, unexplained bladder or bowel problems, history of cancer, night pain, fever or night sweats, unsteady on feet or pins & needles/numbness in both arms or in both legs.

Can I refer for multiple problems?

We request that you refer for just one condition per referral. This is to keep waiting times down and improve the quality of your care.

Once a physiotherapist has completed care for this condition you may then refer again for something else if necessary.

Due to unprecedented referral demand, the Department may take up to 28 working days to process your referral, and up to 18 weeks for you to receive an appointment. Please bear with us during this time and we thank you for your co-operation.

It is important that you select the correct hyperlink below for based in your GP practice as this ensure your referral form is sent to the correct physiotherapy base.

Kingsbridge patients self-referral form

Or post to:

Kingsbridge MSK Physiotherapy Dept,

South Hams Hospital,

Plymouth Road,

Kingsbridge TQ7 1AT

Plymouth patients self-referral form

Or post to :

Physiotherapy Department, Zone E, Level 7,

Derriford Hospital, PL6 8DH

Tavistock patients self-referral form

Or post to :