NHS Health check

Start your healthcheck by clicking on the button below.

It is important to complete every question.

These will then be sent to us by secure email and added to your medical record.

YOUR DETAILS
Your full name *
Your full name
Do you have a learning disability?
If yes, my learning disability is:
LANGUAGE AND ETHNICITY
How would you describe your spoken English?
How would you describe your ability to write?
EXERCISE
SMOKING
What is your smoking status
ALCOHOL
What is your drinking status?
How often do you have a drink containing alcohol?
How many units of alcohol do you drink on a typical day when you are drinking?
(1 unit is half a pint of beer, small 125ml glass of wine, or a single spirit)
How often do you have 8 or more drinks (if male) or 6 or more drinks (if female) in one occasion?
How often during the past year have you found that you were not able to stop drinking once you started?
How often during the past year have you failed to do what was normally expected of you due to drinking?
How often during the last year have you needed an alcoholic drink in the morning after a heavy session?
How often during the last year have you had a feeling of guilt or remorse after drinking?
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
Have you or somebody else been injured as a result of your drinking?
Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?
VISION AND HEARING
How would you describe your vision?
TICK ALL THAT APPLY
How would you describe your hearing?
TICK ALL THAT APPLY
YOUR COMMUNICATION NEEDS
If yes, how do you prefer to be contacted?
What information requirements do you have?
I REQUIRE INFORMATION IN (TICK ALL THAT APPLY)