Active Referral Approved Documents
Active Referral is a selection of physical activity programmes for people with medical conditions, whose health would benefit from being more active. Each programme helps people to be active in a safe environment and manage the symptoms of their condition
Active Referral consists of the following programmes:
- Exercise Referral
- ESCAPE-pain*
- Cardiopulmonary Rehabilitation
- Steady Steps*
- Fit4Surgery Cancer Prehabilitation *
Healthcare professionals wishing to refer patients to Exercise Referral or Cardiopulmonary Rehabilitation should use the approved documents below.
*Requires specialist or self referral.
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Our webpage for residents detailing a selection of physical activity programmes for people with medical conditions, whose health would benefit from being more active.
Active Referral Form (PDF, 543 Kb)
To be used exclusively by designated professionals needing to refer patients who cant access PRISM.
Exercise Referral Standard Operating Procedure (PDF, 1.4 Mb)
Guidance document for local authorities, and healthcare professionals working within Exercise Referral.
Cardiopulmonary Rehabilitation Standard Operating Procedure (PDF, 1.9 Mb)
Guidance document for local authorities and healthcare professionals delivering Cardiopulmonary Rehabilitation Programmes in the community.
Cardiopulmonary Rehabilitation Eligibility Criteria (PDF, 93 Kb)
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What happens to patients data - Exercise Referral and Cardiopulmonary Rehabilitation
For more information please contact:

Andrew Harris
Sports Development Officer
Active Together
I am working flexibly in the office or at home, therefore please contact me via email or phone number provided.
My areas of responsibility are:
- Active Referral (Leicestershire Central Coordination)
- ESCAPE-pain (Leicestershire Central Coordination LCC funded pilots)
- Fit4Surgery Prehabilitation (Cancer) Programme
- Walk, Run, Cycle Together
- North West Leicestershire Link Officer
- Telephone
- 01509 467483
- a.harris@active-together.org