BMI results

Who are you completing this form for?

For example, on behalf of a child or dependent

Yourself

Someone else

What is your name?

First name

Last name

What is your date of birth?

For example, 31 3 1980

Day

Month

Year

What is your sex?

As recorded on your medical record

Male

Female

Other

What is your postcode?

The one used to register with your GP

What is your phone number?

What is your email address?

Anyone else with access to your email account may see responses sent to you

BMI Result

Height: Required

In feet/inches or cm

Weight: Required

In stone/pounds or kg

Age: Required

Sex: Required

Male

Female

Activity level: Required

Inactive – Less than 30 minutes a week

Moderately active – Between 30 and 60 minutes a week

Active – Between 60 and 150 minutes a week

Ethnic group (optional):

Please enter the result from the NHS BMI calculator.

BMI: