Booking the FRP Course

Course Information

How do I book?

You are able to attend the Functional Restoration Programme course if you have suffered spinal pain for more than 3 months. If, on receiving your referral form we feel you need to see your GP first, we will let you know.

To book a place on the course, please complete the steps in the order shown below:

1) Complete the 'Patient Self Referral Form' by submitting your application online or via post by printing, completing and posting the PDF version below to the address shown.

2) Telephone Kelly (07962 977431) or Warren (07890 942254) to book a place. (Please note we cannot confirm your place until we have received your self referral form).

3) We will send a confirmation letter confirming your place subject to payment.

4) Course fees are paid directly to ‘Warren Travers’ or 'Kelly Ridley’.

5) Our FRP courses are run approx every 6 weeks, or as frequently as numbers allow.

Patient Self Referral Form - Print Version

PDF File
This form is in PDF format and requires Acrobat Reader for viewing and printing. Acrobat Reader is available as a free download from www.adobe.com.

Patient Self Referral Form - Online Submission

Privacy Statement

Please note that any information you send to 'Back Pain - The Big Picture' will be dealt with in the strictest confidence according to our patient confidentiality policy. However, please note that we cannot guarantee security should you choose to submit your referral form online or via email to Backpainthebigpicture@mail.com.

Patient's Name
Full Address
Postcode
Telephone (inc. area code)
Email Address
Age (in years)
How long have you had the back or neck problem?

1) Have you been given a diagnosis?	Yes	No
If Yes, please give brief details:
2) Have you had any tests?	X-ray MRI	Blood tests Other
3) Please state any results from the above if you know them:
4) Please answer Yes or No to the following questions:
a) Any changes in bladder or bowel function such as difficulty passing urine or faecal incontinence?	Yes	No
b) Any numbness in the area between your legs?	Yes	No
c) Any recent unexplained weight loss?	Yes	No
d) Any unrelenting night pain?	Yes	No
e) Past history of cancer?	Yes	No
f) History of steroid use?	Yes	No
g) Do you feel generally well in yourself aside from pain?	Yes	No
h) Did your pain begin due to a trauma?	Yes	No
i) Any numbness on your tongue or metallic taste in the mouth?	Yes	No
j) Any Dizziness?	Yes	No
k) Any nausea?	Yes	No
l) Any blurred vision?	Yes	No
5) Please explain what YOU feel is the cause of your back or neck pain e.g. sports injury years ago/ whiplash / began without a cause: