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Health Promotion Service Cornwall and Isles of Scilly


Physical Actvitiy Review

This is undertaken in an informal six stage discussion:

  • Examining an individual’s current activity levels and their history with activity from school to present day, looking at the types of activity previously undertaken and the reasons why this has stopped.
  • An individual’s physical activity likes, which type of activity a person would consider undertaking to increase their activity levels. This can be anything from walking to swimming to chair based activity.
  • Individual’s physical activity dislikes: it is as important to know which activities an individual does not want to do as it it to identify which activities they do want to do.
  • Identifying barriers. Barriers are what stops us from undertaking activity, they can include family commitments, lack of confidence, time or pain. Once the barriers are identified measures are discussed to overcome them.
  • Medical history. This is important as any increase in activity may have an impact on any existing medical conditions. From this recommendations are made to the individual to consider whilst exercising.
  • Goals and wants. These are what really drives the review. Goals and wants are what the individual is trying to achieve by increasing their activity and can range from increasing mobility and health wellbeing and fitness to weight loss.

The idea of the review is to help the individual to achieve their goals and wants, using their physical activity likes avoiding their physical activity dislikes, their barriers and medical history. Anybody requiring a review has to be referred by either their GP or other medical professional. Please note that any conditions that an individual is suffering from have to be stable and under control.

Online referral form

Please complete all mandatory fields marked *

Referring Professional's Details

Name *
Job Title *
Organisation *
Email Address *
Telephone Number *
Address *

Patient details

Full name *
Parent / guardian (if applicable) 
Address *
Postcode *
Date of Birth 
Contact Telephone *
Email address 
Please include all medical conditions / complications. Please note we are unable to work with clients with unstable conditions - refer to brochure for inclusion / exclusion criteria. 
Any additional information - e.g learning / physical disabilities, visual impairment, hearing, access 
Is this referral as a result of a health check? *

Client consent

As a health record this form will be retained in line with the NHS Retention and Destruction Schedule. By submitting this form you consent to us holding this information. *