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Healthy Lifestyles Application Form

Fill in this form to register an interest in the Healthy Lifestyles Weight Management programme.

Please ensure you have read the eligibility criteria - click here for more information.

 

iCM Form
  1. Details
    1. Please fill in the details below then press the 'Send' button
    2. Please tick the status that applies to you
    3. Currently suffering from (please tick any that apply) - this course is not suitable if you have two or more health conditions
    4. Please note you are not eligible for the programme if you are pregnant, post-natal prior to post-natal check or breastfeeding.
    5. Which session would you prefer?
    6. What is your ethnic group?
    7. By submitting this form you are confirming that the information above is correct and you will update the team of any changes that occur. Please note all activities are done at your own risk.