Please answer these safety questions to find out if you can proceed with the self-referral process

  • Do you require urgent medical attention?

    Yes No
  • Is your condition life threatening?

    Yes No
  • Do you have unexplained difficulty controlling or passing urine?

    Yes No
  • Do you have numbness, altered feeling or pins and needles around your back passage or genitals – for example when wiping after toileting?

    Yes No
  • Have you recently developed sudden onset numbness, tingling or weakness in both your legs?

    Yes No
  • Do you have any unexplained difficulties with controlling your bowel motions? Eg: inability to stop a bowel movement or leaking?

    Yes No
  • Do you have sudden or newly worsening pain which extends below the knee in both legs?

    Yes No
  • Do you have new calf pain not related to injury with calf swelling / calf heat / colour change in one leg with or without new shortness of breath?

    Yes No