Weight Management Referral Request

If you wish to be referred to the weight management service, please submit this form.

Weight Management Referral Request

Weight Management Referral Request

Section

BMI

e.g. 1.75
e.g. 60.6

Exercise/activity level:

For more information, please visit NHS: Healthy Weight.

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

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

  • Be over 18
  • Have a BMI over 30 or over 27.5 if you are BAME
  • Have diabetes type 1 or 2 and/or hypertension