ProActive Physical Activity Referral Form and Guidance Notes

If an individual is eligible to attend ProActive, a Physical Activity on Referral Form is then completed by the referring professional.

The Referral Form can be accessed in two different ways:

Primary Care:

For professionals working in Primary Care, the ProActive Physical Activity on Referral Form can be accessed and completed electronically on EMIS. The referral criteria and leisure provider directory can also be accessed here. 

Please read the guidance notes below before completing the referral form.


Other referring health and fitness professionals outside of primary care are able to refer using the online form available below.

Please see the guidance notes below and the referral pathway to assist with completion of the referral form.

How do I refer?

Referral criteria

Referral Pathway