If you have recently or suddenly developed any of the following with the onset of your lower back pain and / or leg pain:
- A change in your bladder function or bowel control.
- Altered sensation around your genitals or back passage.
- Loss of sexual function​.
Do not complete this form and contact NHS 111.
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.
- Widespread pain that has not been reviewed by a G.P.
- If you are unsure if your problem can be resolved with physiotherapy.
Do not complete this form and instead make an appointment to see your G.P.
Do not complete this form if someone at your G.P practice has already referred you for physiotherapy.