The Service

Eating a healthy, balanced diet provides nutrients to your body. These nutrients give you energy and keep your heart beating, your brain active, and your muscles working.

Self Referral Form

Sessions are run over 12 consecutive weeks, and each session is split into 2 parts:

  1. Lifestyle management and healthy eating (45 mins)
  2. Exercise with a qualified exercise instructor (45 mins)

For each session you will need to:

  • bring a bottle of water
  • wear light and comfortable clothing and trainers or similar shoes
  • wear reading glasses, if required

The Eat 4 Health weight management service is only available to people aged over 16 with a BMI ≥ 25kg.m² living or registered with a GP surgery in West Berkshire, Wokingham, Reading, Slough, Windsor, Ascot and Maidenhead. If you have any queries please click here to contact the E4H team.

Title

Forename(s) *

Surname *

Date of Birth *
- -

GP Surgery

GP Name

Ethnicity

Sex

Postcode
Find

Phone *

Mobile

Email

Preferred Language

To assess your suitability for the programme please provide us with the following information:

Weight (stones & pounds) or (kilograms)

Height (feet & inches) or (metres)

Please indicate your preferred location(s)





Do you smoke?

If you are interested in quitting smoking, would you like the local NHS Stop Smoking Service to contact you?

Answer Yes or No to the following questions:

Has your doctor ever said that you have a bone or joint problems?

Has your Doctor ever said you have or have had a heart problem?

Have you ever been diagnosed with epilepsy?

Have you ever been diagnosed with high blood pressure?

Have you ever been diagnosed with diabetes?

Do you suffer from Asthma?

Have you ever been diagnosed with a dietary illness?

Have you ever felt pain in your chest at rest or when you do physical exercise?

Are you currently taking any medication?

In the past year have you had any major illness or surgery?

Do you ever lose your balance because of dizziness or lose consciousness?

Are you pregnant?

Do you know of any other reason why you should not participate in a physical activity programme?