General Health Questionnaire

If you have been asked the practice to complete a General Health Questionnaire, please submit this form.

General Health Questionnaire
Have you been asked by the practice to complete this online review form? *
Please do not fill this form in until you have been asked to complete it by the GP surgery. If you have not been asked to submit this form, you will need to discuss it with the surgery first.

BMI

e.g 1.75
e.g 60.6
Please note: BMI calculator is only for patients aged 18 and over.

Blood Pressure

Please give your latest home Blood Pressure reading if available:

Smoking Status

Please select your smoking status: *
Would you like to arrange an appointment for smoking cessation advice? *

Alcohol Consumption

This is one unit of alcohol:

Amount of different types of drink representing one unit of alcohol

And each one of these, is more than one unit:

Amount of different types of drink representing more than one unit of alcoholAmount of different types of drink representing more than one unit of alcohol
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? *

Exercise

Are you physically active? *

Diet

How would you describe your diet? *