TBC Website | Referrals

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I'm referring myself

I'm referring someone else

This self-referral process is not for clinical use.

Exact height and weight of the individual being referred is required.

1. Name and email

Please choose the GP surgery you are registered with

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2. Your gender

What is your gender?

Male

Female

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3. Your age

What is your age?

Date of birth

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4. Your ethnic group

Please select your ethnic group

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5. Health concerns

Have you been diagnosed with any
of the following health concerns

Asthma/COPD

Cardiovascular disease

Coronary Heart Disease

Dyslipidemia

Hypertension

Intracranial Hypertension

Non-Alcoholic Fatty Liver Disease

Non-diabetic hyperglycaemia

Osteoarthritis

PCOS

Previous Cancer

Sleep Apnoea

Stroke/TIA

Type 2 Diabetes

None

Other

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6. Pregnancy

Are you currently pregnant or recently given birth?

Yes

If yes, please provide a due date or birth date

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7. Other weight management courses

Have you attended and completed any other weight management courses, including the type 2 diabetes path to remission programme within the last 12 months?

Yes

Unsure

If yes, please provide the names of other weight management courses that you have attended and provide the completion dates for them.

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8. Height and weight

Unit of measurement

Height

Weight

Your BMI is 0

Sorry you do not meet our criteria.
Please visit www.nhs.uk/better-health/lose-weight/
for local support in your area.

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9. Your GP surgery

Please choose your GP surgery

Can't find your GP surgery?

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9. Your GP surgery

You are interested in the service, enter name of your GP surgery

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10. Contacts

By submitting this information you are happy for us to contact you

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Thank you!

Thank you. One of our friendly patient care team members will be in touch to discuss your referral.

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Referrals

Get started

1. Name and email

2. Your gender

3. Your age

4. Your ethnic group

5. Health concerns

Have you been diagnosed with any of the following health concerns

6. Pregnancy

Are you currently pregnant or recently given birth?

7. Other weight management courses

Have you attended and completed any other weight management courses, including the type 2 diabetes path to remission programme within the last 12 months?

If yes, please provide the names of other weight management courses that you have attended and provide the completion dates for them.

8. Height and weight

Your BMI is 0

9. Your GP surgery

9. Your GP surgery

10. Contacts

Thank you!

Have you been diagnosed with any
of the following health concerns