Physiotherapy self-referral

Step 1) Download and print form

Step 2) Please fill out the form in BLOCK CAPITAL letters. If you do not know your NHS number please call us on 020 8788 3252.

Step 3) There are 3 ways to send the form:

1) Fax the form to 020 8487 6020

2) Bring the form to reception so we can fax it for you.

3) Post the form to:

Outpatient Physiotherapy

Lower Ground Floor

Queen Mary’s Hospital

Roehampton Lane

SW15 5PN

Step 4) Wait to be contacted by the Physiotherapy department at Queen Mary’s Hospital.

For information on pain, exercises and arthritis etc. please click here.