What is self-referral?

Self-referral allows you to refer yourself directly to physiotherapy without having to be seen by another healthcare professional first.

Each Trust has their own self-referral pathway. The information provided here is specifically for the Northern Health and Social Care Trust (NHSCT).

Please note: If you reside outside of the Northern Trust area, please use the relevant self referral form. Details are provided below.

Who can self-refer?

You can self-refer if you are aged 16 or older, reside in the Northern Trust area, and have a neck or back problem, joint or muscle pain, or a recent injury such as a sprain or strain.

You must consult with your GP prior to self-referring if you:

• Are under the care of a consultant for the same problem
• Require a home-based appointment
• Are seeking treatment for a neurological, respiratory, obstetric, gynaecological or continence condition
• Are seeking treatment for pregnancy related pain
• Are seeking treatment for recurrent falls or headaches
• Have a red, hot, swollen joint
• Have a fever or feel unwell, or
• Have a history of cancer

It is essential that you arrange for urgent advice from your GP or attend your local emergency department immediately if you have experienced any of the symptoms below and you have not seen a doctor for these symptoms:

• A new episode or a sudden change in your ability to pass urine
• A new loss of sensation to your inner thighs, genitals or back passage area
• A new difficulty with bowel function resulting in a loss of control (soiling yourself)

How can I self-refer?

You can self-refer by completing the online MSK Physiotherapy self referral form.

Alternatively, if you prefer to complete a paper copy, you can download the MSK Physiotherapy self referral form in Microsoft Word and print the form. Paper copies of the form are also available from your GP practice, or any of the Northern Trust Physiotherapy departments.

Paper copies should be completed in full and sent to:

Physiotherapy Central Booking Office
Robinson Hospital
Newal Road
Ballymoney
BT53 6HH

What happens after I have submitted my self-referral form?

Once the central booking office have received your referral it will be triaged by a physiotherapist within two working days. The physiotherapist will determine if you require routine or urgent assessment. If additional details are required, the physiotherapist may contact you on the telephone number you provided. Your referral will then be added to the waiting list. You will be contacted by letter or telephone to invite you to attend an appointment.

If the physiotherapist determines that your condition or problem is not suitable for physiotherapy, or may require a more specialist setting, they will facilitate this for you.

What should I do whilst waiting for my initial appointment?

There are many resources available both from the Northern Trust and elsewhere which we encourage you to use to help manage your condition while you wait. Our website provides physiotherapy resources to guide you to appropriate, evidence-based information and support online.

Privacy Policy

All information and data collected in the self-referral form will be managed in line with Northern Health and Social Care Trust Privacy Policy (PDF).

If you require more information, please contact the Trust’s Data Protection Officer at:

Information Governance Department
Causeway House
8e Coleraine Road
Ballymoney
BT53 6BP

Email: info.governance@northerntrust.hscni.net

Tel: 028 2766 1293

Self referral forms for other trusts

Belfast Trust MSK Physiotherapy Self Referral Form
South Eastern MSK Physiotherapy Self Referral Form
Southern Trust MSK Physiotherapy Self Referral Form
Western Trust MSK Physiotherapy Self Referral Form