KLINIK ACCESS

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Hypertension Review Form

Hypertension Review
Enter Email
Confirm Email
Please use format day/month/year e.g. 12/05/1979

Hypertension Review

Do you have any specific issues with your blood pressure which you would like to discuss further? *

Height, Weight and BMI

Weight

Unit of measurement *
cm
kg
ft
in
lbs

BMI

Underweight
Healthy
Overweight
Obese

Do you smoke?

1 unit = 1 small glass of wine, half pint of beer/lager, single measure of spirit/whisky/vodka etc
Do you smoke? *
How often do you exercise per week (at least 30 minutes)?

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.