Use this service to request a referral to a specialist NHS Tier 3 weight management programme.
Tier 3 services are specialist NHS programmes designed to support patients with complex weight-related health needs.
There is currently a long wait for Tier 3 services. Submitting this form does not guarantee a referral. Your eligibility will be checked.
Eligibility criteria
You may be eligible for referral to a Tier 3 weight management service if you meet one of the following:
Option 1 – BMI 35 to 39.9 (or 32.5 to 39.9 if of South Asian heritage)
- You have completed a structured weight management programme
- You have at least one long-term health condition
Option 2 – BMI 40 to 49.9
- You have completed a structured weight management programme
- A long-term condition is not required
Option 3 – BMI 50 or above
- No other criteria required
If you do not meet this criteria, you have access to Health Dudley, NHS Digital Weight Management, Health and Welling Coaches.
Important: Important
We are currently unable to initiate Mounjaro in General Practice.
Before you start
We’ll ask you for:
- your first and last name, date of birth, sex, postcode, email and phone number
- if applicable, the details of the person you are completing the form on behalf of
You can also phone us on 01384 254423 or visit the surgery in person.