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Update Clinical Records

Smoking Cessation - Do You Want To Quit?

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Alcohol Cessation - How Much Is Too Much?

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1Your Details

2Personal Details

Please specify if in feet & inches or centimetres
Please specify if in stones and pounds or kilogrammes
Please specify if in inches or centimetres

3Smoking

4Alcohol Consumption

In order to work out your Alchohol units please use the simple formula: Strength (ABV) x Volume (ml) ÷ 1000 Eg. Pint of Fosters: 4.9 x 598 ÷ 1000 = 2.9 Units

5Special Diet

e.g. Vegan, Vegetarian, Diabetic

6Children


Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


Your Neighbourhood Professionals. Just a Click Away! Set up a lasting power of attorney before you lose capacity and it Oakhaven Residential Care Home Cheltenham Chiropractic Clinic Ltd Abbeyfield Gloucestershire Society Badham Pharmacy
93 St George's Road, Cheltenham, Gloucestershire, GL50 3ED
  • Telephone (01242) 255337
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Your Neighbourhood Professionals. Just a Click Away! Set up a lasting power of attorney before you lose capacity and it Oakhaven Residential Care Home Cheltenham Chiropractic Clinic Ltd Abbeyfield Gloucestershire Society Badham Pharmacy
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