Queens Road Partnership - Update Clinical Record

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BBC Health News

Music 'calms nerves before surgery' as well as sedative19 Jul 2019 00:36The "world's most relaxing song" could be just as good at calming patients' nerves, a study suggests.
Plant-based milks on the rise: A quarter of Britons are drinking them19 Jul 2019 06:46Whether it's almond, soy or coconut it seems cow's milk is being ditched for alternatives.
NHS boss: Tax bills could mean 'loss of 60 doctors'19 Jul 2019 16:00Doctors' refusal to work overtime is the issue, its chief executive warns.
Measles outbreak: Loddon head teacher makes immunisation plea18 Jul 2019 18:57Loddon head teacher Jim Adams writes to parents after three pupils contract the disease.
Wolverhampton hospital's 'regret' over new mum's death19 Jul 2019 15:22The trust running Wolverhampton's New Cross says lessons have been learned to better manage sepsis.
UTI home-testing app to help women trialled by NHS18 Jul 2019 17:28The app guides users through a urine test and allows the results to be analysed online by a pharmacist.

Update Clinical Record

Please help us to keep our clinical records up to date by providing the information below.

If you need help understanding the blood pressure recording please visit http://www.bloodpressureuk.org/BloodPressureandyou/Thebasics/Bloodpressurechart

1Your Details

Title

First Name

Surname

Date of Birth

Are you able to provide your NHS or Patient Number?This will allow us to locate you quickly on our Patient Database.

NHS Number

2Your Address

Address

Post Code

3Your Contact Details

E-mail Address

Home Phone Number

Mobile Phone Number

4Physical Attributes

HeightSpecify if in Feet & Inches or Centimetres

WeightPlease specify if in Pounds, Stones or Kilogrammes

Waist MeasurementPlease specify if in Inches or Centimetres

Blood pressure top/upper value

Blood pressure bottom/lower value

5Lifestyle Choices

Have you ever smoked?

If yes to the previous question do you currently smoke?

If 'no' you don't currently smoke, when did you quit?

If you do currently smoke how many do you smoke a day?

There are plenty of options available to help you quit. Is this something you would like us to contact you about?

Do you drink alchohol?

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?

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?

6Additional Information

Are you a carer?

Are you allergic to any medications?

What is your ethnicity?

What is your first language?

Other Information

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 known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to
Queens Road Partnership • 387 Queens Road, New Cross Gate, London, SE14 5HD.

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.

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