Refer to us

    Some of the 1:1 support options are currently unavailable due to a temporary reduction in our capacity due to Covid-19.

    We would ask that from this point onwards all patients are signposted in the first instance to the One You South Gloucestershire website for details of the support available.

    You can still refer patients into our Wellbeing Team via the contact form or call 01454 865337, our Tier 2 Adult Weight Management Service LifeShape (WW vouchers) via the referral form on EMIS and we are accepting self-referrals for stopping smoking support via the contact form or call 01454 865502.

    Please remember - If you have a service for stopping smoking at your GP practice, you need to use your in house
    service before referring to us.

    Tell us about the patient you would like to refer

    About the person you would like to refer

    Is the referral part of a:

    About the person you would like to refer

    Date of birth

    For example, 01 08 1997

    About the person you would like to refer

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


    About the person you would like to refer

    Are they registered at a South Gloucestershire GP Surgery

    About the person you would like to refer

    Which of the following topics are they interested in?

    Tick all that apply

    About the person you would like to refer

    About them

    The information they provide enables us to check that we give a good and fair service to everyone and
    identify
    how we could potentially improve our services to them in the future.

    All their answers will be treated in the strictest confidence and will only be used to monitor and help
    improve our services.

    You can read more about our monitoring in our privacy policy.

    Equalities monitoring

    What is their ethnic group?

    Includes any Asian background, for example, Bangladeshi, Chinese, Indian, Pakistani


    or

    Includes any Black background


    or

    Includes any Mixed background



    or

    Includes any White background



    or

    Includes any other ethnic group

    or

    Equalities monitoring

    What is their sexual orientation?

    or

    Equalities monitoring

    Are they a carer for someone?

    or

    Equalities monitoring

    What is their current employment status?

    or

    Equalities monitoring

    What is their religion?

    or

    Equalities monitoring

    Do they have a disability?

    This could be a physical or sensory impairment, mental health condition, learning disability or
    difficulty, long standing illness or health condition.



    or

    About the person you would like to refer

    How would they prefer to be contacted about this referral?

    About them

    The information you provide enables us to check that we give a good and fair service to everyone and identify
    how we could potentially improve our services to you in the future.

    All your answers will be treated in the strictest confidence and will only be used to monitor and help
    improve our services.

    You can read more about our monitoring in our privacy policy.

    Equalities monitoring

    What is their ethnic group?

    Includes any Asian background, for example, Bangladeshi, Chinese, Indian, Pakistani



    or

    Includes any Black background



    or

    Includes any Mixed background



    or

    Includes any White background



    or

    Inclues any other ethnic group

    or

    Equalities monitoring

    What is their sexual orientation?

    or

    Equalities monitoring

    Are they a carer for someone?

    or

    Equalities monitoring

    What is their current employment status?

    or

    Equalities monitoring

    What is their religion?

    Equalities monitoring

    Do they have a disability physically or mentally?

    How did they hear about us?
    Other

    Submit referral

    The information provided will be used to provide the service. It will only be shared with our partners
    involved with delivering One You South Gloucestershire, in accordance with South Gloucestershire Council's privacy notice.

    Your patient or client may tell us at any time if they would like to stop the service or update their
    details.

    Once we receive the referral, we aim to contact your patient or client within two working days. We regret
    we will not be able to confirm receipt of referrals.

    If your patient or client is registered with a South Gloucestershire GP, we will give feedback to their
    practice on whether they receive support from us as a result. We will not give any details of the
    support provided.

    Select Yes if you agree to these terms and conditions.

    As your patient or client does not give consent for us to receive and use their data, call us on
    01454 865337 so we can help with the enquiry.