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Update my Records

Please complete the form to update your existing records with the surgery.
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Name and address

First Name*
Last Name*
Date of Birth*
Address Line 1
Address Line 2

Contact details

Home Phone Number
Mobile Number
Work Number
Email Address*
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Clinical details

Blood Pressure


Do you smoke?
Current smoker
Date stopped smoking

Drinking alcohol

How often do you have a drink containing alcohol?

How often?

How many units of alcohol do you drink on a typical day when you are drinking?

Units on a typical day?

How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?

Units on a single occasion?

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