Get Nhs Lothian Podiatry Self Referral Form

Filling out the NHS Lothian Podiatry Self Referral Form online is an important step towards addressing your foot health concerns. This guide will walk you through each section of the form, ensuring you provide the necessary information accurately and completely.

Follow the steps to successfully complete your referral form online.

1. Click the ‘Get Form’ button to obtain the Nhs Lothian Podiatry Self Referral Form and open it for editing.
2. Begin by providing your title (Mr, Mrs, Miss, Ms) followed by your forename and surname in the designated fields.
3. Enter your address, date of birth, postcode, and phone numbers (home and mobile). Optionally provide your work phone number.
4. Indicate whether you give permission to leave a message on your phone by selecting 'Yes' or 'No'.
5. Fill in your General Practitioner’s name, practice address, and contact number.
6. Provide an emergency contact's name, relationship to you, and their contact number.
7. State if you require an interpreter by selecting 'Yes' or 'No', and indicate which language is needed.
8. Clearly outline the reason for your referral to Podiatry in the provided section.
9. Select the affected side (Left, Right, Both) and the region of concern such as Toes, Foot, Heel, or Ankle.
10. Indicate the specific structure affected (Nails, Skin, Joint, Muscle/Tendon, Leg, Knee, or Hip).
11. Describe the condition of the problem area (Red, Swollen, Bleeding/Discharging/Weeping) and whether you are currently on antibiotics for this issue.
12. Specify how long you have had this complaint by selecting the appropriate duration (Days, Weeks, Months, Years).
13. Indicate if the symptoms are worsening and confirm if you are currently off work due to this problem.
14. List all current medications you are taking, or attach a recent prescription list.
15. Tick any general health conditions that apply to you (e.g., diabetes risk, neurological disorders, etc.) and specify any additional conditions.
16. Select your preferred clinic location from the options provided.
17. After completing all sections, review your form for accuracy, save your changes, and proceed to download, print, or share the completed form as necessary.

Now that you have the necessary guidance, begin filling out the NHS Lothian Podiatry Self Referral Form online today.