Active Families - Health Care Referral

Child
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Child
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Child
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Child
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Child
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Child
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1 = Interested in change but needs lots of encouragement, 10 = Self starter, needs some support.

By checking the box we give consent for Sport Wellington to get information from our medical centre necessary for the programme and for our GP to be updated about our progress. In signing up to take part in Active Families we will do our best to get involved and participate but understand that we can stop being on the programme at any time.

Thank you for your referral, a confirmation email will be sent to you within 7 working days.
If you have any queries please contact the GRx Child and Whānau Lead on: (04) 380 2070 ext. 225 or 021 650 107.