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MSK self referral

Online self referral form for musculoskeletal (MSK) services for patients from Middlesbrough, Redcar and Cleveland.

Important

Please seek urgent medical assistance if you have a temperature, a hot swollen joint, suspected infection or feel generally unwell, or if you have noticed any changes to your bowel or bladder habits, numbness in between your legs or intimate area and DO NOT complete this form.

Please read before submitting this form

The MSK service can only accept referrals for people living in the Middlesbrough or Redcar and Cleveland county boundary areas and you should be registered with a GP practice in Middlesbrough or Redcar and Cleveland. 

If you live outside this area please contact your GP, as a referral to the MSK service would be rejected.

The information you tell us on this referral form will enable the form to be triaged by a clinical practitioner and your referral will then be directed to the service that is most appropriate to help you at your first appointment.  This may include, but is not limited to: physiotherapy, podiatry, the Tees Musculoskeletal Service and pain management services.

If you feel you would benefit from a physiotherapy assessment and discussion, please contact your GP practice as you may benefit from seeing a First Contact physiotherapy practitioner who are based in your GP practice. Your GP practice can arrange this appointment.

If your referral requires an initial assessment by your GP, your completed referral form will be returned to you and a copy sent to your GP practice.

Tees Musculoskeletal Service accepts referrals for

  • peripheral joint problems

  • peripheral soft tissue problems

We do not accept referrals for

  • spinal conditions including neck, upper back and lower back problems

  • patients who are already being treated in secondary care for the same problem

  • circulation problems or ulcerations

  • patients under 18 years of age

  • those with inflammatory arthritis such as rheumatoid arthritis

  • nerve related conditions

  • fractures or suspected fractures or tendon ruptures and Dupytrens contractures

  • if you feel very unwell

  • recent accident or injury

If you feel you need a more detailed assessment which may include further management, please continue with the self-referral form below:

MSK self referral form

(If known)

Reason for referral

Please answer the following questions so we can understand your problem

Include any history of cancer, diabetes, heart problems
(such as physiotherapy assessment)
Please tick the box next to the part of the body you are referring for(Required)
The MSK service does not accept referrals for spinal problems
For example aggravating factors, easing factors, pain level, pain at night, activities your symptoms prevent you from undertaking.
Privacy policy(Required)