Contact

Complete our form and a member of our team will be in touch

Tell us about you

First name

Last name

Gender

FemaleMaleOtherPrefer not to say

Date of birth

For example, 01 08 1997

DateMonthYear

What is your postcode?

We use this to help link you to local services in your area

Are you registered at a South Gloucestershire GP surgery and over 18?

Yes

Select your GP surgery

Which of the following topics are you interested
in?

Tick all that apply

Be smoke freeDrink lessMove moreEat wellManaging my weightImproving my mental health and emotional wellbeingSleep betterPrefer not to sayOther

Type your topic you are interested in *

Your enquiry

Type what you would like to enquire about

How would you like us to contact you about your enquiry?

Enter your email

Phone

Enter your phone number

Post

Enter your address

or
Prefer not to be contacted about my enquiry

How did you hear about us?

FacebookTwitterLocal advertisingWord of mouthHealth or care professionalSearch engine e.g Google or Bing

Other

Enter how you heard about us

Submit your enquiry

Your information will be used to provide the service and will only be shared with our partners (see our partners ) involved with delivering One You South Gloucestershire in accordance with the South
Gloucestershire Council privacy notice You may tell us at any time if you would
like to stop the service or update your details.

Do you give consent for your information to be used by One You South Gloucestershire as stated above?

YesNo

As you do not give consent for us to receive and use your data, please call us on 01454 865337 so we can help you with your query