vector image of receptionist in office We hold copies of your patient health record electronically and in paper format. When you register with the practice and your registration documents have been processed, your Electronic Record can reach us within minutes.

FAST KEYS MEDICAL RECORDS
MEDICAL RECORDS
TRANSFER GP 2 gp
PATIENT RECORDS
ACCESS VIA NHS APP
REGISTER AS A
PATIENT FIND OUT MORE
ABOUT THE NHS APP
A COPY OF YOUR
MEDICAL RECORDS
MEDICAL RECORDS
(PATieNTS ASSoCTN)

Updating Your Clinical Record

Contact Details

Name* Address 1* Address 2* City * Postcode*

Date of Birth * Landline phone Mobile phone email

About this form

Thankyou for completing this form. This information submitted will help us keep your records up-to-date and accurate.

Field marked * are compulsory

By completing this form you will be transmitting personal information across the internet. Since the media cannot be guaranteed as 100 % secure, your absolute privacy cannot be guaranteed. If you have concerns, please use a different method of providing the information.

Personal Data

Personal data retained on our clinical systems is stored in a secure UK data centre and is treated as confidential.

Height & Weight etc

Height

Feet Inches cm

Weight

Stone Lb OR kg

Waist

Feet Inches OR cm

Blood Pressure

Systolic Diastolic

Smoking

Have you ever smoked?

If you answered "Yes" to having smoked in the past please answer the following:

Do you smoke now? If "Yes, "How many a day? If "No," when did you stop? There are plenty of available options to stop smoking. If you are a smoker would you like us to contact you to discuss?

Alcohol

1 drink= 1/2 pint of beer or 1 glass of wine or 1 single spirits
1 unit of alcohol = 10cc of alcohol. So, a small glass (125cc) of wine is 12.5 x 0.12 = 1.5 units

MEN: How often do you have EIGHT or more drinks on one occasion? WOMEN: How often do you have SIX or more drinks on one occasion? How often during the last year have you been unable to remember what happened the night before because you had been drinking? In the last year, has a relative or friend, or a doctor or other health professional been concerned about your drinking or suggested you cut down?

Other Info

Do you look after someone?

If yes, please provide the following details

Caring Details:Permission date:Relationship to patient:Are you allergic to medications?
(If so please specify)
What is your ethnicity?
What is your nationality?
Please specify your first language