Eat, Move, Be Happy Enrolment
If you are interested in enrolling in any of our programmes, just fill out the form below to sign up.
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Email *
First name *
Last name *
Post code *
Your District
Additional NHS funding is reserved for two residential areas.  Please click if you live in one of these districts.
Contact number *
Emergency contact name *
Who should we contact in case of emergency?
Emergency contact details *
The email or phone number of your emergency contact.
Date of birth *
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/
DD
/
YYYY
Which GP practice are you registered with? *
Medical conditions or disabilities
Please tick if you have any of the following:

Who referred you to Eat Move Be Happy?

 *
Name of referrer
Please give the name of the GP, Social Prescriber, Physio etc who has referred you (if applicable).
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