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Podiatry Referral Form

Patients eligible to request an assessment for treatment must be in the following priority groups which are recommended by the DHSS and have a foot problem:

  • Male/Female 60+ with a foot problem
  • Child under 16 with a foot problem
  • Expectant/Nursing mother with a foot problem
  • Diabetic with a foot problem
  • Registered Disabled with a foot problem
  • Patient with a medical condition which places them at risk without treatment
  • Patient requiring Nail Surgery

If this sounds like you please download the form and return it completed via post or email to:

Department of Foot Health
Primary Care Offices
West Bromwich
B71 4HJ


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