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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
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Your email
First name
*
Your answer
Last name
*
Your answer
Post code
*
Your answer
Contact number
*
Your answer
Emergency contact name
*
Who should we contact in case of emergency?
Your answer
Emergency contact details
*
The email or phone number of your emergency contact.
Your answer
Date of birth
*
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Which service are you interested in?
*
For full descriptions of all the services on offer, go to
www.EatMoveBeHappy.com
Choose
Healthy Choices SILSDEN - 8 weeks to prevent cardiovascular disease
Healthy Choices SKIPTON - 8 weeks to prevent cardiovascular disease
Live Better - 12 week health coaching programme
Live Better PLUS (Only available to graduates of the Live Better Course)
Get Moving Exercise classes
Wellbeing Coaching
One to One Coaching
Funding options
*
Are you paying for yourself, or do you have funding confirmation from one of our exclusive partners?
Choose
Funded
Self Funded
Funding organisation
If you have confirmation of funding from one of our exclusive partners, please name their surgery/organisation below (eg - Age UK Bradford, etc). If you are self funding, please leave blank.
Your answer
Medical conditions or disabilities
*
Please tick if you have any of the following:
High blood pressure
Cardiovascular disease
High cholesterol
Diabetes/Pre diabetes
Excess body weight (BMI 30+)
Mental health condition
Learning disability
Sedentary lifestyle
Stroke
MS
Parkinsons
Other:
Required
Which GP practice are you registered with?
Your answer
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