Mental Health Review

If you have been advised by the surgery to submit a Mental Health Review please use this form.

Mental Health Review

Mental Health Review

About You

Please use this date format: DD/MM/YYYY.

We will only use this email address for correspondence in relation to this request and will not sell it onto third parties.

In Meters e.g. 1.63
In KG e.g. 63

Mental Health Review

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Alcohol Consumption

This is one unit of alcohol:

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

Alcohol Consumption - Part 2

A total of 5+ indicated increasing or higher risk of drinking. As you have scored 5 or more, please now fill in the questions below.

Blood Pressure Reading

Please note that if you do not have a home blood pressure monitor this can be done in the practice using our Surgery Pod. There is no need to make an appointment for this to be done.