NHS digital weight management programme referral request

NHS Digital Weight Management Programme Referral Request

Height (in Meters): *

eg. 1.75

Weight (in Kilograms): *

eg. 60.6

BMI:

Ethnicity: *

Exercise / Activity level: *

Exercises regularly

Gets little exercise

Gets no exercise

For more information, please visit NHS: Healthy Weight.

Do you consent for referral to weight management services, provided you meet the referral criteria? *

Yes

To be eligible for the weight management service, you must meet the following criteria:

I confirm that I meet the referral criteria and I understand that if I do not meet the criteria, my referral request will be rejected.

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