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Health professionals referral form (not public)

Instructions

Visit our Health and Wellbeing pages for more information on our Health and wellbeing activities and the range of programmes we offer. 

Before completing this form please ensure:

  • You have permission to provide the individuals personal and medical information
  • The individual is over 18

Exclusion criteria for signposting to community activities:

  • People who are aged under 18 years, unless the activity specifies differently
  • People who  need 1-2-1 support or who cannot cope in a group setting, (we are happy for someone to be supported by a carer, social prescriber or other health professional)
  • Anyone with serious uncontrolled/undiagnosed condition or are awaiting further investigation
  • Anyone with an uncontrolled mental health condition
  • Anyone with an acute infection or showing Covid 19 symptoms
  • Anyone who in the health professional’s opinion is not medically fit to take part in 12 weeks of physical activity

Once your form is submitted a member of our active lives and community engagement team will be in touch to discuss available options.

Please review our privacy notice to understand how we protect your data.

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