Self-Referral and other Downloadable Forms 

Below you will find a list of services that patients are able to refer themselves to, including instructions and any forms that may be required for you to print and complete.  
The NHS have a Self-Referral Physiotherapy Service. 
To book an initial telephone consultation with the service, call their booking centre on 0300 300 0046, Monday to Friday 09:00 - 16:00. Do not call this number regarding appointments at the Physio department at the Leicester Royal Infirmary, Leicester General or Glenfields Hospitals 
When you call you will need to ensure you have your NHS Number available. This can be found on the NHS app, on SystmOnline or alternatively ask the Practice and we will provide you with this information.  
This service is NOT suitable for: treatment in your home; under 16 year olds; breathing problems; continence issues; stroke or other neurological conditions. The GP will need to refer you to a different service, so please book an appointment to discuss with a GP if you fall into one of these categories. 
The Leicestershire Podiatry Service aims to keep the population mobile, help users keep their independence and maintain their quality of life by providing an expert and complete range of foot and lower limb care, for those with a clinical need. 
They deliver the service from various sites across Leicester, Leicestershire and Rutland, strategically placed to provide care where it is most needed, bringing care closer to home. 
They treat a range of foot conditions where there is a medical need, including: 
- Those with a foot problem and a medical condition that could lead to foot ulceration or amputation 
- Painful toenails (You will be managed and then discharged once your treatment is completed) 
- Diabetic patients with a foot problem 
- Open wounds below the ankle for 4 weeks or longer 
- Children with foot pain 
- Sudden red, hot, swollen foot with or without an open wound 
- Assessment and treatment of Musculoskeletal problems associated with walking or running. 
To self refer to the service you can complete the online referral form here or print a paper copy of the form here and once completed post it to the address on the top of the form. 
A Prescription Prepament Certificate (PPC) could save you money if you pay for your NHS prescriptions. 
The certificate covers all your NHS prescriptions for a set price. You will save money if you need more than 3 items in 3 months, or 11 items in 12 months. Click here to start your application for a PPC. 
If you get prescriptions for hormone replacement therapy (HRT), you may save more with the Hormone Replacement Therapy Prescription Prepayment Certificate (HRT PPC). If you pay for NHS prescribed HRT medicine 3 or more times in 12 months, an HRT PPC could save you money. Click here to start your application for the HRT PPC. 
Before buying a PPC, check if you’re entitled to free NHS prescriptions and other help with health costs using the NHS eligibility checker. Click here to use the eligibility checker. 
Social prescribing is a service designed to support and help people with a wide range of social, emotional or practical needs. 
They aims to link patients into local services that can help them manage finances, meet new people, maintaining/finding employment, managing their mental health, techniques to manage a physical health condition or building more physical activity into their week. 
If you feel you might benefit with their support with one of the above, than please print and complete this form and hand it into the Practice. 
The Practice is able to offer appointments for Travel Vaccines with the Practice Nurse. However, we are unable to provide vaccines for 'last-minute' travel, so to be able to process your request for an appointment, there will need to be a minumum of 8 weeks until you intend to travel. 
If you are intending on travelling, please print off and complete the following assessment form, (Click here) alternatively you can pick up a copy of the form from reception. Once completed please hand into reception. The nurse will then review your form and your medical records to decide whether you require any vaccinations. If you do they will then contact you to book an appointment. 
If you are travelling within the next 8 weeks we advise that you contact either Travel Doc (freephone 0800 583 3331 w: or Superdrug (w: Superdrug Travel) 
General travel advice and useful information regarding specific countries can be found on the NaTHNaC Travel Health Pro website. Click here to be taken to their website. NaTHNaC is the National Travel Health Network & Centre. They are a UK government organisation which produces travel health guidance for healthcare professionals advising travellers as well as for travellers going overseas from the UK. 
In partnership with the NHS, Vita Health Group provide Talking Therapies services to adults 16-years and over, who live and are registered with a GP in Leicester, Leicestershire and Rutland. 
They offer support to help patients improve their mental health and patients experiencing: 
- Depression 
- Low mood 
- Excessive worry or overthinking (generally or about your health or physical condition) 
- Stress and anxiety 
- Panic attacks 
- Sleep problems 
- Phobia(s) 
- Obsessive Compulsive Disorder (OCD) 
- Experience of a traumatic event 
Gaining support with any of the above is easy, you can self-refer by going to the VitaMinds website and using one of the options there. This can be done via the website, completing their online form or calling them by phone. 
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