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.
Email address *
First name *
Last name *
Contact number *
Date of birth *
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Funding options *
Which GP practice is funding you. If you have not had CONFIRMATION of funding from your GP, choose "Self Funded".
Which service are you interested in? *
For full descriptions of all the services on offer, go to www.EatMoveBeHappy.com
Preferred start date *
From when can you start? We cannot promise this date, but we will do our best to accommodate.
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Medical conditions or disabilities
Please tick if you have any of the following:
What do you want to achieve from completing this programme? *
How confident are you at achieving this goal? *
Not confident
Very confident
How confident are you at managing your weight? *
Not confident
Very confident
How confident are you at managing your health and wellbeing? *
Not confident
Very confident
How confident are you at managing your exercise and activity? *
Not confident
Very confident
Where did you hear about this programme? *
Disclaimer *
I acknowledge I take part in this programme under my own free will and accept full responsibility. The contents of this programme are for information purposes only and are not a substitute for professional medical advice.
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