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Making a difference

Steve Bapchild, 53, tells us about his experience of the X-PERT diabetes course: "I can't praise the X-PERT course enough. By making aSteven Taylor few small changes to my lifestyle I have lowered my average blood sugar levels from 9 to 6." Read more...>

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Your experience is important to us and we are keen to hear from you about how we can continue to improve our services. Tell us >

Diabetes team - referral form

Diabetes team - referral form

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The importance of sharing information with all professional staff involved in the patients care has been explained to the patient or carer


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Interpreter required: * required


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Type of diabetes: * required





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Reasons for referral: * required













HbA1c(mmol/mol)

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Blood pressure

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eGFR

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Height (m)

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Weight (kg)

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BMI (kg/m2)

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Waist circumference (cm)

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For referral to be accepted please attach or input relevant past medical history and current medications



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You will see a thank you page once the form has been submitted. If you do not see this page then you have overlooked to complete some of the required fields. Please check the form, complete the missing details and resubmit. Thank you.

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