Patient review information updates form
Dear patient we are updating your medical record and need some information from you.
You should use the secure form below to send us the required information.
Blood Pressure:
We need an update of your latest BP readings:
- If you have a BP machine at home, could you please send us your readings so that we could add this to your records.
- If you do not have a BP machine at home you can turn up at the surgery during Monday to Friday 9am to 12pm and 2pm to 4opm to have your BP checked.
Smoking Status:
We need an update of your smoking status:
Please let us know if you are;
- Current Smoker
- Ex Smoker
- Never Smoked Tobacco
Help is available to quit smoking
Please note if you are a current smoker and wish to get help to quit smoking- please follow the link for NHS Smoking cessation helpline to help you stop smoking which has several health benefits.
Only complete this form is you have received a message from the surgery asking you to do so.
Patient review information updates form
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This information is not shared with any third party organisations.
This information is retained for up to 28 days.
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Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.