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Please note: It is important that you provide us with a recent height and weight measurement in order for us to discuss the most appropriate pathway available to you and your needs. There is equipment available locally to measure yourself if it's been a while - such as in Wakefield One (main offices), all Wakefield Council leisure centres and many of the districts pharmacies.
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Thank you for completing the online self-referral.
Based on the details you have entered, we will require more details to be able to progress your Aspire Health Referral. Please contact us on 01924 306069 / 01924 306765 to discuss.
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If you are interested in stopping smoking, please visit the Stop Smoking Service website wakefield.yorkshiresmokefree.nhs.uk for more information.
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Thank you for completing the online self-referral.
Based on the details you have entered, we will require more details to be able to progress your Aspire Health Referral. Please contact us on 01924 306069 / 01924 306765 to discuss.
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Based on the answers you have provided you will be referred to the Aspire Health Referral programme.


Please enter your name and address details and complete the declaration below.

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By selecting the agree box, I confirm that I that have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that a Trustee (such as my employer, community/fitness centre, health care provider, or other designate) may retain a copy of this form for their records. In these instances, the Trustee will be required to adhere to local, national, and international guidelines regarding the storage of personal health information ensuring that they maintain the privacy of the information and do not misuse or wrongfully disclose such information. (For more information, please see our Transparency Notice)

I understand the information provided is essential to my application and I consent that this information will be entered into a database and stored securely in accordance with the General Data Protection Regulations (GDPR - 2018) and Wakefield Council Policy. I agree to be contacted by letter, email, telephone and SMS text message.
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