Lifestyle Medicine Programme – Registration Form

Full Name *

Email Address *

Phone *

Pronouns

Preferred Name

Which of the following best describes why you are interested in the programme? (Tick all that apply)

Which sessions would you prefer?OnlineFace-to-faceHybrid

What days are usually best for you? (Tick all that apply)

Do you have any accessibility, communication or support needs that you would like us to be aware of? *We want everyone to feel comfortable attending our sessions.YesNo

If yes, please tell us how we can best support you:For instance, do you require any support with the following: Hearing, Visual, Mobility requirements, Learning disability, Neurodiversity-related adjustments, Quiet environment, or Other

Is there anything else you would like us to know?