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Visiting and directions
- Harrogate
- Ripon
What to expect
Classes
Exercise at home
For professionals

Join Us
Visiting and directions: Harrogate
What to expect
Classes
Exercise at home
For professionals
About us
Support us
Donate
Contact us

Healthcare professional referral to Active Against Cancer

Healthcare professional referral

Access the service for your patient

Please note: Healthcare professionals can now refer via WebV. If you have access to WebV please refer via that method. Otherwise, continue with this form.

Is the patient being treated at Harrogate Hospital?(Required)

Yes

No

Does the patient live in the Harrogate district?(Required)

Yes

No

To be referred to Active Against Cancer, please confirm the patient meets the following criteria

Be over 18 years old

Be able to understand and follow simple instructions within a group setting

Please confirm patient also meets one of the following conditions

Has been diagnosed with cancer within the last 12 months

Has had treatment for their cancer (NOT including long-term hormone therapy) within the last 12 months

Will commence treatment for their cancer (NOT including long-term hormone therapy) within the next 3 months

If your patient does not meet these criteria please call 01423 557924 to discuss with a member of the Active Against Cancer team.

Name of referring health professional(Required)

Title First Last

Job title(Required)

Location(Required)

Contact telephone(Required)

Contact email(Required)

Name of patient(Required)

Title First name Last name

Date of birth(Required)

Hospital number

NHS number(Required)

Diagnosis (details of diagnosis, past, current and planned treatments)(Required)

Stage of treatment(Required)

New diagnosis (not started treatment)

In treatment

Finished treatment

Known medical conditions

Angina

Anxiety

Asthma

Cardiac surgery

CFS

COPD

Cystic Fibrosis

Depression

Diabetes

Hypercholesterolemia

Hypertension

Joint Replacement

Multiple Sclerosis

Obesity

Osteoarthritis

Osteoporosis

Rheumatoid Arthritis

Stroke / TIA

Type 1 Diabetes

Type 2 Diabetes

Previous MI

Pacemaker

Other

Please specify other known medical conditions

List of current medications(Required)

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Active Against Cancer, Harrogate and District NHS Trust 2

Active Against Cancer is a high-quality health and wellbeing service for people living with cancer in Harrogate, with exercise at its core. Our exercise classes are delivered in a safe environment by specialist trainers.

Join our community

Keep up-to-date with our community by joining us on social media.

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Find out about opportunities to volunteer or get involved with fundraising for local cancer services.

Contact us

Active Against Cancer is based at Harrogate Sports and Fitness Centre. We also have a venue at the Jack Laugher Leisure and Wellness Centre in Ripon.

info.activeagainstcancer@nhs.net

Hookstone Wood Road

Harrogate
North Yorkshire
HG2 8PN

Dallamires Lane

Ripon
North Yorkshire
HG4 1TT

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