Risk Assessment: Type 2 Diabetes

If you have been advised by the surgery to submit a Type 2 Diabetes risk assessment please use this form.

We can refer patients, who have been told that they are at risk of developing type 2 diabetes, to the Healthier You programme.

By joining this programme, patients will receive a personalised support plan including advice on healthy eating and lifestyle, help to lose weight and physical exercise programmes.

Risk of Type 2 Diabetes Referral form

Risk of Type 2 Diabetes Referral form

Please use this date format: DD/MM/YYYY. Your date of birth is required to verify your identity.
This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.