Adult Weight Management – Self-Referral

Please complete this form if you would like to self-refer onto the Slimming World programme.

You can check your criteria here.

Find your NHS number here https://www.nhs.uk/nhs-services/online-services/find-nhs-number/

Adult Weight Management – Self-Referral
Name
Name
First
Last
Address
Address
City
County
Postcode
Are you over the age of 18?
Are you registered with a Warwickshire GP?
Do you live in Warwickshire in one of the eligible postcodes? (if you are not registered with a Warwickshire GP)
*People with a South Asian, Chinese, Other Asian, Middle Eastern, Black African or African-Caribbean family background are more at risk of heart conditions and other health conditions therefore a lower BMI is used.

You can check your BMI here

Which of the following apply to you?
Data Consent