NHS Digital Weight Management Programme

What is your forename? *

What is your surname? *

Are you 18 or over? *

Yes No

What is your email address? *

What is your date of birth? *

What is your height? (In meters) *

How much do you weigh? (In kilograms) *

Do you have a BMI greater than 30? (Or 27.5 if you are from a Black, Asian, and ethnic minority background, as people from these ethnic backgrounds are at an increased risk of conditions such as Type 2 diabetes at a lower BMI) *

Yes No

What is your exact BMI? (BMI Calculator- https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/)

Do you have diabetes, high blood pressure, or both? *

Yes No

Do you have a smartphone, tablet, or computer with internet access? *

Yes No

Do you agree to be referred to the NHS Digital Weight Management Service? *

Yes No

NHS Digital Weight Management Programme

Further Information