Make A Referral

If you’re a healthcare professional and feel that one of your clients could benefit from a free NHS Health Check or ongoing one-to-one support from one of our Health Trainers then please complete the form below.

Before referring a client please explain to them that their information will be securely stored on paper and electronically in accordance with the Data Protection Act and that someone from the Health Trainer Service will be in contact with them as soon as possible.

To download a Word version of the Referral Form click here.

  • REFERRER DETAILS

  • CLIENT CONSENT

  •  Yes No
  • CLIENT DETAILS

  •  Male Female
  •  Telephone Mobile Email
  • REASON(S) FOR REFERRAL

  •  Health Check (aged 40-74) Health Trainer Both
  •  Alcohol Diet Exercise / Physical Activity Long Term Condition Mental / Emotional Health (Stress) Smoking Weight Management Other
Make a Health Trainer Referral

Book a Health Trainer

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