Self-referral Form

REFERRAL FORM INFORMATION

Please read all sections carefully before completing your referral form. If any sections are left blank you will not be offered an appointment and the referral form will be returned to you.

It is very important that we have a full picture of your medical condition including any medication you may be taking currently.

It may be necessary for us to contact your GP to obtain further information about your condition.

WHAT HAPPENS NEXT?

• Your referral is assessed against the criteria for eligibility to receive NHS Podiatry.
• Eligible patients are notified by post and asked to contact the booking centre to make an assessment appointment. If they do not contact the centre within 3 weeks of receiving this letter the referral is discharged.
• All non-eligible applicants will be notified as soon as possible by letter.

Podiatry Service Referral Criteria         

Patients must have a foot problem / podiatric need from the list below.

Acute Podiatric Needs

• Foot Infection
• Foot Ulceration
• Suspected Acute Charcot
• In-growing toenail that requires nail surgery

Chronic Podiatric Needs

• Corns, callus or nail conditions in combination with one of the High-Risk Categories:
  • Peripheral neuropathy in feet with loss of protective sensation on monofilament testing
  • Peripheral arterial disease with absent or monophasic foot pulses
  • On ‘End of Life’ care pathway
  • Diabetic on renal replacement therapy (dialysis)
• Structural foot problems requiring podiatry musculoskeletal (MSK) assessment e.g. foot and ankle pain, associated knee / hip pain, congenital deformities, disease related foot deformities, paediatric foot and ankle delayed development

We do not accept referrals for:

• Annual diabetic foot assessments
• Vascular checks
• General footcare or nail care without a risk to the limb
• Social nail care for normal nails
• Fungal nails
• Verrucae
• Bunions

This list is not exhaustive and may be updated or amended.