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Weight Management in Pregnancy Self-Referral Form

1. Weight Management in Pregnancy Support

Self-referral guidance
  • To complete this form you will need your height, weight and BMI. Click here to check your BMI 
  • We can only accept self-referrals for pregnant adults with a BMI of 30 or above (or 27.5 if from Asian, Black, Chinese or Middle Eastern ethnic group). 
  • If your BMI is below this range please visit (The Best Start Hub) During pregnancy - Betsi Cadwaladr University Health Board and the Foodwise in Pregnancy app for self-directed support.
  • This form is for self-referral only. If you wish to refer someone else, please ask your health professional to refer using the healthcare professional referral form or contact:  BCU.DieteticsAdultWeightMgt@wales.nhs.uk
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Question 1.

First name

- Required.
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Question 2.

Surname

- Required.
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Question 3.

Address and Postcode

- Required.
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Question 4.

Are you registered with a GP in North Wales?

- Required.
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