You can self-refer to our service by completing the self-referral form below.

Please complete all the boxes in the referral form below as fully as possible. You must complete all the boxes marked*. 

(dd/mm/yyyy)

(This is your personal number that starts with your date of birth, you can find it on letters received from Health Care Providers).


By submitting this form, you consent to us processing your data for referral purposes.



The referral form will then be automatically sent (by secure email) to the Adult Weight Management and Type 2 Diabetes Prevention Service who will contact you in due course. If you haven't heard from us within 4 weeks or if you have any queries about your referral, please contact the service direct on 01383 674086.

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