Diolch i chi am gymryd y cam cyntaf tuag at flaenoriaethu eich iechyd a'ch lles gyda'r Prosiect Mae Eich Iechyd yn Bwysig. Mae'r ffurflen hunan-atgyfeirio hon wedi'i chynllunio i'ch helpu i ymuno â'n cymuned a chael mynediad at yr adnoddau a'r gefnogaeth sydd ar gael i chi.

Thank you for taking the first step towards prioritising your health and well-being with the Your Health Matters Project. This self-referral form is designed to help you join our community and access the resources and support available to you.
Gwybodaeth personol / Personal Information:

Question Title

* 1. Enw / Name

Question Title

* 2. Oedran / Age

Question Title

* 3. Location / Lleoliad

Question Title

* 4. Rhyw / Gender

Question Title

* 5. Galwedigaeth / Occupation

Question Title

* 6. Cyfeiriad e-bost / Email address

Question Title

* 7. Rhif ffôn / Phone number

Question Title

* 8. Statws Iechyd Presennol:
Disgrifiwch yn gryno eich statws iechyd presennol ac unrhyw nodau iechyd penodol sydd gennych:

Current Health Status:
Briefly describe your current health status and any specific health goals you have:

Question Title

* 9. Sut clywsoch chi am prosiect 'Mae Eich Iechyd yn bwysig?' / How did you hear about 'Your Health Matters' project?

Question Title

* 10. Rhesymau dros Hunan-atgyfeirio:
Gwiriwch unrhyw un o’r rhesymau canlynol sy’n berthnasol i chi:

Reasons for Self-Referral:
Check any of the following reasons that apply to you:

Datganiad:
Rwy’n deall, trwy gyflwyno’r ffurflen hon, fy mod yn dewis bod yn rhan o gymuned y Prosiect 'Mae Eich Iechyd yn Bwysig'. Rwy'n cytuno i dderbyn cyfathrebiadau sy'n ymwneud â'r prosiect, gan gynnwys cylchlythyrau, gwahoddiadau i ddigwyddiadau, a diweddariadau.

Declaration:
I understand that by submitting this form, I am opting to be a part of the Your Health Matters Project community. I agree to receive communication related to the project, including newsletters, event invitations, and updates.

Question Title

* 11. Llofnod / Signature

Question Title

* 12. Dyddiad / Date

Date
Camau nesaf:
Unwaith y byddwch yn cyflwyno'r ffurflen hon, byddwch yn derbyn e-bost croeso gyda gwybodaeth am gael mynediad i'n hadnoddau ar-lein a digwyddiadau sydd i ddod.

Dilynwch ein tudalennau cyfryngau cymdeithasol i gysylltu â'r gymuned a chael y wybodaeth ddiweddaraf am awgrymiadau a gweithgareddau iechyd. Mae prosiect 'Mae eich iechyd yn bwysig' wedi ymrwymo i rymuso unigolion ar eu taith iechyd. Croeso i gymuned sy'n rhoi blaenoriaeth i'ch llesiant

Next Steps:
Once you submit this form, you will receive a welcome email with information on accessing our online resources and upcoming events.

Join our social media platforms to connect with the community and stay updated on health tips and activities. Your Health Matters Project is committed to empowering individuals on their health journey. Welcome to a community that prioritizes your well-being.

T