Update your basic health information

Only complete this form if you are registered with the Practice.

Your personal information provided will be solely used to update your medical records. It will not be passed to any third party, without your consent, unless required by law. This conforms to the Data Protection Act of 1998.

For further information regarding general lifestyle advice please visit NHS Health Choices.

Thank you for agreeing to help us keep your medical records up to date.

Your details







Your height and weight


Your smoking status

Yes
No

Alcohol consumption

Yes
No

Allergies

Yes
No

Your ethnic group

For carers



Terms and conditions

The internet is not secure and the transmission of data to change health information is enirely at the patient's own risk. The practice accepts no responsibility for breaches in confidentiality resulting from patients' transmissions.