Live Well Referral Form

About this form

Please use this form to refer into the Live Well Swindon Hub for the following services provided by the Community Health and Wellbeing Team. * Before making the referral please refer to the summary and eligibility criteria (SEC1)

  • Stop smoking service and Health Checks *
  • Community Navigators *
  • Health Ambassadors and Befriending Service
  • Disability Sport
  • Health Walks
  • Swindon Circles *
  • Adult weight management and Child weight management *
  • Steps to Health (Exercise Referral) *
  • Healthy Lives (Pulmonary Rehab) *
  • Supervised Gym Sessions *
  • COPD classes *

I give consent for the personal details on this form to be shared (along with my health records if appropriate) with the Community Health and Wellbeing Team and I confirm that I have read and agree to the Privacy Statement on this referral form.                                                                                

I understand that I am responsible for monitoring my own responses during my involvement with any programme and will inform the officer in charge of any changes to my health or medication which could affect my participation. 

PadlockPrivacy Notice

By completing the following form, you confirm you have read and understood our Privacy Notice, which outlines how we intend to use your personal data.

Please read the Privacy Notice before continuing
(Opens in a new window)