Make A Referral

If you’re a healthcare professional and feel that one of your clients could benefit from a ongoing one-to-one Health Trainer support or free NHS Health Check 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 discuss their needs, assess their eligibility and arrange a convenient time for an appointment.

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

  • REFERRER DETAILS

  • CLIENT CONSENT

  • YesNo
  • CLIENT DETAILS

  • MaleFemale
  • TelephoneMobileEmail
  • REASON(S) FOR REFERRAL

  • Health Check (aged 40-74)Health TrainerBoth
  • AlcoholDietExercise / Physical ActivityLong Term ConditionMental / Emotional Health (Stress)SmokingWeight ManagementOther
Make a Health Trainer Referral

Book a Health Trainer

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