Patient Health Questionnaire
To help us keep your medical record up-to-date, we would be grateful if you would take a few minutes to complete our Health Questionnaire. The information requested is basic and is of course confidential.
Additionally, the Department of Health has asked all G.P practices to ascertain the smoking habits of their patients so that services and resources can be directed to those patients wishing to quit.
It is therefore important that patients completing these forms confirm whether or not they are a current smoker, a past smoker or have never smoked tobacco.
If you do not wish to complete the medical records update online, please contact us and we will arrange a paper copy to be sent to you.
Patient Health Questionnaire
Smoking Status
General Measurements & Blood Pressure
Privacy Protection
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure
connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
Learn more about our Privacy Policy and
Terms of Use.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.