Straight2Physio (Self-Referral Form)

Contact Physio Directly on: 0161 720 2321 (Mon-Fri, 8.30am-16.30pm) or complete the referral form.

Last Updated: 24/09/2021

Please Fully Complete This Form to Enable The Physiotherapist to Fully Access Your Needs

If you are not a registered patient of The Avenue Medical Centre this form will not be processed


Your Details











About Your Current Problem



Your Consent;


Next Steps

You can print and email this form to mft.NMGHPhysioRefer@nhs.net or simply complete the form and our reception staff will send the form to the service for you. Any completed form received by the practice will be sent to the service- Thank you.