See below copies of self-referral forms which can be completed by patients and submitted without the need for a GP/Nurse Practitioner/Nurse appointment.

Forms can either be completed digitally and emailed using the email addresses provided on the forms or alternatively the forms can be printed and posted to the addresses provided on the forms.

Please ensure all sections are complete as the forms may not be processed.


Please note referrals will not be accepted from Diabetic patients; if you are a diabetic and you require assessment from the Podiatry Team please contact the Surgery: 01900 815544

Unless you are already under the care of the Podiatry Team in which case contact the Podiatry Team at Workington: 01900 705120

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