Manchester Sports Medicine Clinic

Injuries

Education

Services

Referrals are accepted from GP's and Therapists only.

You can also email us with any queries, although we cannot provide medical advise and consultations via this route.

Please use this referral form only if, you are a Physiotherapist, GP or other medical professional who is wishing to refer a patient for treatment at the Manchester Sports Medicine Clinic.
NB Please note that any information you submit via this site is NOT secure at present. If there are details which you consider confidential then please feel free to omit them from the form and contact a member of our staff directly.

Complete this form and then Click on Submit when ready to send.

Referrer's (Your) Details:

Your name:
Practice name:
Practice address:
Email address
Telephone:
	Please indicate how you would prefer to be contacted:
Your patient's details:
Patient's name:
Date of Birth:
Patient's address:
Patient's Email:
Patient's telephone
	Patient's history and reason for referral:
Clinical Hours Clinical sessions are in progress Monday to Friday. One of our surgeons is always available and we can accommodate urgent and emergency referrals within diary constraints. Office Hours Office hours are from 8am to 5pm, Monday to Friday. Outside these hours we have an answer phone giving emergency contact details.