Update of Basic Health Record

 
Page {{ paginatorProps.current }} of {{ paginatorProps.total }} ({{ paginatorProps.percentage }}% completed)

All questions marked with a * are mandatory

Personal Details
Please double check you've entered the correct email address
May be used to identify you
Processing
Ethnicity & Religion
Do you speak English?:
Do you read English?:
Will you require an interpreter when you see the doctor/nurse?:
Processing
Height, Weight, BP & Smoking status

Update your Height

What unit of measurement are you using?:
Conversion from Feet & Inches to Centimetres

Update your Weight

What unit of measurement are you using?:
Stones & Pounds Converted to Kilograms
Update your Smoking Status
Please choose from one of the following options:
Are you interested in further advice and support on how to quit?:
Stop Smoking

Steps to quit smoking

Stopping smoking lets you breathe more easily. People breathe more easily and cough less when they give up smoking because their lung capacity improves by up to 10% within 9 months.

  NHS Stop Smoking Services

  Take steps now to stop smoking

  10 self-help tips to stop smoking

Update your Blood Presure or Heart Rate

Your systolic blood pressure is the top number on your reading
Your diastolic blood pressure is the bottom number on your reading
Your pulse rate is the number of times your heart beats per minute
Processing

Privacy Consent

Processing

There appears to be a problem loading the form, please refresh the page.
If the error persists please contact us.

Providing NHS Services

Beaumont Street Surgery
19 Beaumont Street
Oxford
Oxfordshire
OX1 2NA

Elms Road Surgery
Elms Road
Oxford
OX2 9JS

Telephone: 01865 240501