Queens Road Partnership - Update Clinical Record

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BBC Health News

Whorlton Hall: Ten arrested over abuse allegations24 May 2019 14:36Ten workers are held over the alleged mistreatment of hospital patients following a BBC investigation.
'Cancer screening should be as easy as booking a flight'24 May 2019 13:21Text reminders and after-work appointments are recommended in a report on improving cancer screening.
Surgeons warn of serious hand injuries from dog leads and collars24 May 2019 01:19A Cornwall dog owner had the skin torn off her middle finger by a lead wound tightly round her hand.
Mumps and measles cases in England prompt vaccine call24 May 2019 01:16There were 795 cases of mumps in the first three months of 2019, versus 1,031 in the whole of 2018.
Migraines: Calls for 'life changing' drug Aimovig on NHS in England24 May 2019 07:24The 'life-changing' injection has been approved for use in Scotland, but not yet in England.
Whorlton Hall: Hospital abuse missed despite at least 100 official visits23 May 2019 17:10Inspectors, council staff and NHS officials went in twice week on average in the year before Panorama expose.

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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Queens Road Partnership - 387 Queens Road, New Cross Gate, London, SE14 5HD

Telephone 020 7635 2170

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Key Information