General Health Review

If you have been advised by the surgery to submit a general health review please use this form.

General Health Review

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.

Smoking Review

Do not currently smoke section

Do currently smoke section

Please find more information on how you can stop smoking in the Wellbeing Centre

Alcohol Review

This is one unit of alcohol:

And each one of these, is more than one unit:

This is your total score from the first part of the Alcohol Consumption form.

Alcohol Consumption - Part 2

A total of 5+ indicated increasing or higher risk of drinking. As you have scored 5 or more, please now fill in the questions below.
This is your total score the Alcohol Consumption form.

Please note that the details you give will be used to update your medical records.