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Get help for back pain

Get help for back pain
Required fields are labelled
Who are you completing this form for?
For example, on behalf of a child or dependent
What is your name?
What is your date of birth?
For example, 31 3 1980
What is your sex?
As recorded on your medical record
The one used to register with your GP
Anyone else with access to your email account may see responses sent to you

About the Patient’s Problem

If you’re not sure, it’s helpful to tell us whether it’s been days, weeks, months or years.

Back Pain or Sciatica

Where is your pain? Required

Since your back pain started, have you had any of the following new symptoms?

If you develop any of these symptoms, you should contact 111 immediately
Numbness or tingling around your genitals or buttocks Required
If the numbness or tingling is only in the lower back, answer No.
New difficulty peeing Required
Loss of bladder or bowel control – peeing or pooing yourself Required
Pain spreading down both legs to below the knees Required
A high temperature Required
Chest pain Required
Weak legs Required
If you are only struggling to move because of pain, answer No. If your legs feel weak, answer Yes.

Since your back pain started, have you had any of the following new symptoms?

Unintentional weight loss Required
A swelling or deformity in your back Required
The pain is so bad you’re having problems sleeping Required
The pain does not improve after resting or is worse at night Required

Additional questions

Have you consulted a physiotherapist?
Do you have a history of gastric ulcer (stomach ulcer), gastric bleeding, gastritis, duodenal ulcer or duodenitis? Required

File Upload

Please send photos if you think a photo would help our clinicians.

Do not upload sensitive photographs of genitalia, bottoms (anus), breasts or minors without asking a healthcare professional first. Your uploads may be stored on your health record.

Communication Preferences

How would you like us to deal with the problem? Required
Video Consultation

Video consultations require you to have a smartphone, tablet, laptop or any computer with camera and microphone or headset. You will also require access to the internet, preferably over WiFi. If the practice decides on a video consultation you will be sent an email containing a link for the video consultation, so it’s best if you can receive your emails on that same device.

How quickly do you think the problem needs to be dealt with? Required

If the practice has a mobile number for you, we may send text messages to this number to inform you of an appointment time, or to allow you to book an appointment at a time of your choice.

Terms & Conditions Required