Health Questions - New Patients

Please complete this online form if you have been asked to do so by the practice. 

This is to enable us to ensure your records are up to date and to allow us ensure you're record is up to date and to enable us to provide further support where necessary. 

Last Updated: 30/06/2023

Your Details





Smoking Status







Alcohol Section

Pint of lager = 2.3 units

Pint of Strong beer / lager / cider = 3 units

Large glass of wine = 3units

Single spirit = 1 unit 

Alco-pop = 1.4 units


Height / Weight / Exercise





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