If you have recently or suddenly developed any of the following with the onset of your lower back pain and / or leg pain:
- Difficulty initiating the passing of urine
- Inability to stop or control your bladder or bowel
- Numbness, tingling or loss of feeling around your genitals or back passage
Do not complete this form and contact NHS 111 straight away.
If you have any of the following:
- Any unexplained weight loss.
- Any Weakness or numbness/tingling in one or both of your arms and hands.
- Dropping things or feel that your hands feel clumsy.
- Are feeling generally unwell / feverish.
- Have recently become unsteady on your feet or frequently off-balance.
Do not complete this form and contact your G.P surgery or NHS 111.
If you are:
- Under 16 years old.
- Unable to attend a hospital outpatient department.
- In need of physiotherapy at home.
- Seeking treatment for Neurological, Pelvic Health or Respiratory physiotherapy.
- Suffering from widespread pain that has not been reviewed by a G.P.
- Unsure if your problem can be resolved with physiotherapy.
Do not complete this form and instead make an appointment to see your G.P.
If you are seeking help for a Pelvic Health problem, please complete a self-referral via this link - sussexlmns.org/pelvic-health-physiotherapy-referral
Do not complete this form if someone at your G.P practice has already referred you for physiotherapy.