Helping you to reach your goals

Exercise Referral Forms

This page provides access to our exercise referral forms for each scheme. Please ensure you choose the correct form for your area/scheme.

Norwich Activity Referral Scheme

Download Forms

GP Referral PDF FormDownload (PDF)

GP Referral Word Document FormDownload (Word)

Please Send Forms To:

  • Benefit Health & Fitness
  • 14a Church Close
  • Coltishall
  • Norwich, NR12 7DL

South Norfolk (Wymondham, Diss, Long Stratton)

Download Forms

GP Referral PDF FormDownload (PDF)

GP Referral Word Document FormDownload (Word)

Please Send Forms To Relevant Leisure Centre:

For leisure centre addresses please go here

Dereham

Download Forms

GP Referral PDF FormDownload (PDF)

GP Referral Word Document FormDownload (Word)

Please Send Forms To:

  • Exercise Referral Scheme
  • Dereham Leisure Centre
  • Station Road
  • Dereham, NR19 1DF

Poringland & Framlingham Earl

Download Forms

GP Referral PDF FormDownload (PDF)

GP Referral Word Document FormDownload (Word)

Please Send Forms To:

  • Benefit Health & Fitness
  • 20 Potters Bar
  • Dereham
  • Norfolk, NR19 1HN