Plain text version
Professionals can use this form to refer someone you are supporting, through your organisation, to one or more healthy lifestyle services available in North Somerset. You'll need a new form for each person you refer.

Questions marked with * are mandatory.

If you have any questions about this form, contact us by email or by phone on 01934 427 661.

Once you have submitted this form, the service/s you have referred to will be in contact with the person you have referred within 10 days.
Choice of scheme(s) you want to refer the person to
 * Which service or services do you want to refer someone to?

Tick any that apply. Hover on the question mark to see information about that service.
 Services marked with a also accept self-referral
Health Trainers

Health Trainers provide one-to-one support for up to 12 sessions (approx. 30 minutes per session).  Topics of support covered include eat healthier, exercise more, lose weight, stop smoking and reduce alcohol consumption.
 * Let's see if the person is eligible for the Health Trainer service. Are they...?
 Yes No 
 18 or over  

 Living in Weston-super-Mare  
 To be eligible for the Health Trainer service, they have to be able to answer 'yes' to both questions.  
 
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