Pending Referrals Form

Referrals to be added to "Wait List"

We are not currently accepting new referrals to the project. However, if you would like to be added to a "Wait List", then we'd be grateful if you'd complete this quick survey.

If you have any queries, please contact anyone from the HWB Team on 01792 544006. Thank you

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* 1. Your Full Name

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* 2. Where would you like to receive the programme session(s)?

In the home

Within a community group/setting

Within a school

As a stand alone workshop

Other (please specify)

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* 3. What type of referral do you want to make?

Making a referral for yourself/family

Making a referral for someone else

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* 4. What are your reasons for making this referral?

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* 5. What do you hope that you/the family/ the group will gain from taking part in the HWB Abertawe Project?

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* 6. Please select from the list below, things that you would like to be included within the programme you receive (you can select more than one!)

Develop cooking skills and knowledge

Develop budgeting and meal planning skills

Improving food nutrition and healthy eating knowledge

Improving physical activity levels

Understanding portion size and 'me size meals'

Other (e.g. weaning, quick meals, healthy snacks etc.)

Pending Referrals Form

Referrals to be added to "Wait List"

Question Title

* 1. Your Full Name

Question Title

* 2. Where would you like to receive the programme session(s)?

Question Title

* 3. What type of referral do you want to make?

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* 4. What are your reasons for making this referral?

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* 5. What do you hope that you/the family/ the group will gain from taking part in the HWB Abertawe Project?

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* 6. Please select from the list below, things that you would like to be included within the programme you receive (you can select more than one!)

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* 7. Please note any dietary or support requirements that you/any participants may have.

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* 8. Additional information (anything else you would like to add)

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* 9. Contact Details:-