Update Your Clinical Record

In order for us to maintain and keep your medical records up to date, we would be grateful if you could fill in our questionnaire.

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Update Clinical Records
Title
Address
Address
Post Code
City
Country

Height and Weight

(In Feet & Inches OR cm)
(In stone & lbs OR kg)

Smoking

Have you ever smoked tobacco?
If you are currently a smoker and would like to stop please contact the surgery to discuss this further.

Alcohol

(1 drink = 1/2 pint of beer or 1 glass of wine or 1 single spirits)

Depression

Could you be depressed ?

Carer

A carer is someone who looks after an elderly person or someone who is disabled. We do not mean a carer of a child.

Are you a Carer?