Perinatal Pelvic Health Service postnatal self-assessment / referral

Before completing this self-referral form, please check that you are eligible to access the North Cheshire and Mersey Perinatal Pelvic Health Service.

This self-referral pathway is intended for patients who:

• are registered with a GP within the North Cheshire and Mersey area; and / or
• are currently receiving antenatal or postnatal care through North Cheshire and Mersey NHS Foundation Trust services.

If you do not meet these criteria, please contact your GP, Midwife, Health Visitor or local Perinatal Pelvic Health Service for advice regarding referral to the appropriate service in your area.

This postnatal form should be used to make a referral to the Perinatal Pelvic Health Physiotherapy Service (PPHS).   

Please complete all sections of this postnatal referral form to the best of your ability. This will ensure we can best align your care tailored to your pelvic health concern.

After completing your form, you will either be sent a link with information and resources available, or an invitation to a workshop which can be watched at home (pre-recorded version), or attended online or in person, depending on your local area provision and availability. In some instances, you will be offered a face-to-face appointment with the clinical specialist team.

If your symptoms change at any point, or you do not feel you have received the care you need, you can re-refer at any time up to 18 months postnatal or you can speak to your midwife, GP or health visitor.