Health and Wellbeing Coaches Self-Referral

Have you been thinking about making
lifestyle changes to improve your health and wellbeing?

Do you have a long-term health condition?

If yes, self-refer online to receive one-to-one support from the Health & Wellbeing Coaches for up to 12 weeks to help you:

  • Take more of an active role in your health and wellbeing
  • Access personalised support to Identify and achieve your health-related goals
  • Overcome any obstacles in your way

Potential topics and benefits:

  • Manage stress in a positive and natural way
  • Eat better without feeling miserable
  • Get active no matter what challenges you face
  • Throw fad diets and super strict eating out the window
  • Feel better and more confident so you can get the most out of life
  • Prioritise sleep so you feel better every day
Health & Wellbeing Coach Service leaflet

Self-Referral Form- Rosewood PCN Health and Wellbeing Coaches

Please complete the below form and ALL the information will be passed onto the Health and Wellbeing Coaches to review and process referral if suitable

General Details

Name
Address
DD slash MM slash YYYY
Are you Pregnant?
Is an interpreter required?
Are you a patient at Roundwood Surgery?
(If not we won’t be able to accept your referral)
Do you consent to your information being shared with the health and wellbeing coaches?
(if not we won’t be able to accept your referral)
Reason for referral (please tick ALL that apply)