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Tier 3 weight management service request

Tier 3 Weight Management Service Request

Section

in cm or feet/inches
in kg or stones/pounds

(This will be used to calculate your Body Mass Index or BMI.)

Health Background

Have you completed a structured weight management programme?
Please select all that apply
Do you have any long-term health conditions?
Please select all that apply

Understanding and Consent

Screening acknowledgement
Waiting times
Consent to contact