Healthy Active Minds Referral form

Last Updated: 14/03/2023

Healthy Active Minds Referral Form

Health Active Minds Project is run by Edinburgh Leisure. Please fill in the details below if you are wanting to be referred to Healthy Active Minds.

Full name *

Date of Birth *

Email Address *

Please state the mental health problem *

Please state preference of activity plan(s) you would be interested in participated in. *

Yoga classes

Swimming

gym

exercises classes

walking group

don't know

Please state any physical impairments that might make it difficult for you to participate in certain physical activities.

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