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Update your Records

Please note: It is important that you read our terms and conditions before using this service.

Updating your records is important, especially if you don't come to the surgery all that often. With updated records, we can look after your health needs even better than we would be able to with old records.

Please fill in your details and click the 'Update' button at the bottom of the form. Your details will then be sent to us and we will update your records.

Please fill in ALL fields
Use your TAB button, or your mouse to move from one field to the next. Pressing enter to go to the next field will click the request button and you will be taken to an error page.
You must be a registered patient to use this service.
You must click the tick box to accept our terms and conditions of service.

First Name

Surname

Date of Birth                                         Phone Number
                    
E-mail Address



What is your Height?

What is your Weight?

Smoking
Do you smoke?                               
Yes    No

If yes, what do you smoke?          

If so, how much do you smoke per day?   

Would you like information on giving up smoking?
Yes    No

Alcohol

One unit is 10 grams of alcohol and can be found in:
Half a pint of Beer
Less than half a pint of Export Lager, Lager or Strong cider. (A 440ml can of cider =2.3 units)
A small glass of wine (a 75cl bottle contains between 7&9 units)
A small sherry (a 75cl bottle = 13 units)
A pub single measure of spirits (a 75cl bottle of whisky = 28 units)

How much do you drink per week (units)  

Alergies

Do you have any know allergies?


I accept the terms & conditions

                                                          
 

 
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