Update your patient record

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Date of birth Required
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Height and Weight

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Smoking

Do you currently smoke?
How many do you currently smoke per day?
Would you like us to contact you with advice on giving up smoking?

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Alcohol

1 drink = 1/2 pint of beer or 1 glass of wine or 1 single spirits. 1 unit of alcohol = 10cc of alcohol. So, a small glass (125cc) of 12% wine is 12.5 * 0.12 = 1.5 units.

MEN: How often do you have EIGHT or more drinks on one occasion? WOMEN: How often do you have SIX or more drinks on one occasion? * Required
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
How often during the last year have you failed to do what was normally expected of you because of drinking?
In the last year has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down?

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Other information

Are you a carer
What is their date of birth
IS THE PERSON YOU CARE FOR REGISTERED AT THIS SURGERY
Required