Patient self-referral information for patients in South East and South West Essex
If you live in Basildon, Rochford, Thurrock, Canvey, Southend or Rayleigh area and have a foot condition that fits our criteria and requires treatment, you no longer need to visit your GP, simply fill out the corresponding self-referral form to make a direct application for treatment.
Podiatry appointments office
- Phone::
- 01375 364465
- Email::
- [email protected]
- Opening Times:
- Monday to Friday, 10am to 4pm
How to self-refer to SEE Podiatry
Use the links below to download the appropriate self-referral form for the type of treatment you require.
- Please ensuring you have read and understood the referral treatment guidelines for the service you are applying to and complete every section in full.
- Failure to complete all sections can increase the chance of your application being-rejected.
Self-referral forms
application-form-for-ingrowing-toenail-surgery-2023_reviewed (265kB docx)
application-for-podiatry-chiropody-treatment-2023_reviewed (200kB docx)
application-form-for-podiatry-biomechanics-treatment-2023_reviewed (201kB docx)
Step 2 – Check your condition meets the criteria that is detailed within the application form.
Step 3 – Return your completed self-referral form either by post or email. If you need any help please contact the Podiatry appointments office on 01375 364465 and someone will be happy to assist you.
Send via email to: [email protected]
Return by post to:
EPUT Podiatry Services
Ashingdon House
Rochford Hospital, Union Lane
Rochford
Essex SS4 1RB