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REFERRAL TO THE STAYING WELL SERVICE Please note that all clients referred to this service must be at least 18 years of age. Please return this form to:E: stayingwellproject@calderdale.gov.uk or Post:
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Open the new-staying-well-referral-formdocx document on your computer.
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Fill in the required personal information such as name, contact details, and date of birth.
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Provide details about your current health status, including any medical conditions or symptoms you are experiencing.
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Include information about any medications you are currently taking or any allergies you may have.
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If applicable, indicate any specific concerns or goals you have for improving your health and well-being.
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Review the completed form to ensure all necessary information has been provided.
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Save the document and submit it to the appropriate healthcare provider or organization as instructed.

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The new-staying-well-referral-formdocx is a document used for referring individuals seeking assistance through the staying well program.
Individuals or organizations that support or provide wellness services and need to refer clients to the staying well program are required to file this form.
To fill out the new-staying-well-referral-formdocx, you should complete all required fields, providing accurate and complete information about the individual being referred and the services they require.
The purpose of the new-staying-well-referral-formdocx is to formally document and facilitate the referral process for individuals who need access to wellness services.
The form must report the individual's personal information, the reason for referral, and any relevant medical or social history that may assist in their care.
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