Active Lifestyles Self Referral Form
1. Personal Details
You can self refer to the programme using the form below, or for more info contact the Healthy Communities team on: 01224 507701 or email: activelifestyles@sportaberdeen.co.uk
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Gender *
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Ethnicity *
Do you have a physical or mental health condition or illness lasting or expected to last 12 months or more?
Do you consider yourself to have a disability?
Do you consider yourself to have a caring role? (this is anyone of any age who helps a relative, friend or neighbour who cannot manage without their support and has taken on an unpaid caring role in addition to their existing commitments)
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Do you have any of the medical conditions listed below? *
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Health screening questionnaire *
How active are you currently? E.g. activity could be walking around the block daily/gardening or housework/attending an exercise class once a week