NHS Health Check

During the COVID-19 pandemic we have had to change the way that we carry out our NHS health checks. As part of our new way of working, if you have been invited for an NHS Health Check, please complete the questionnaire below. Once you have completed the questionnaire, please ring our Reception to arrange a face-face appointment where our staff will take further measurements and some blood tests.

You may not be eligible for an NHS health check if you have a number of different health conditions. Please also note that patients are only offered one NHS health check every 5 years.

Please only complete this form if you have been invited for a health check. The form has been divided into sections for ease of use, due to the amount of information that we need to collect.

Your Details

Your Height and Weight

To measure your waist:

1. Find the bottom of your ribs and the top of your hips
2. Wrap a tape measure around your waist, midway between these points
3. Make sure it’s pulled tight, but isn’t digging into your skin.
4. Breathe out naturally before taking the measurement

Your Blood Pressure

If you don’t have a blood pressure monitor please write a note in the box

On each day, monitor your blood pressure on two occasions: in the morning (between 6am and 12noon) and again in the evening (between 6pm and midnight). If you are prescribed blood pressure medication then take this usual, unless told otherwise by a doctor.

On each occasion take a minimum of two readings and record the lowest, leaving at least a minute between each. If the first two readings are very different, take 2 or 3 further readings.

Take your blood pressure before eating, as digesting food can lower your blood pressure. If you must eat first, wait 30 minutes after eating before taking a measurement. It is also important that you haven’t had a cigarette within 30 minutes of taking your blood pressure as smoking can increase your readings.

Your Diet

Your Smoking History

Your Alcohol Data

Your Exercise

Your Mental Health

Your Family History

For family members that have any of the above conditions please indicate their relationship to you and the approximate age that they were, when they were diagnosed.

If no family members are affected then please add this to the box

Fields marked with an asterisk (*) are mandatory