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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

Although sending information across the Internet means that privacy of data cannot be absolutely guaranteed, our online forms offer high levels of security. The forms use HTTPS and TLS (using a 2048 bit certificate) to encrypt data sent to and from your computer when using the site and our server environment is PCI DSS certified - the highest standard of security associated with e-commerce and online finance solutions.

Form submissions are stored on the server for 28 days and are encrypted and secured with a private key known only by the GP Practice.

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! Oakhaven Residential Care Home Badham Pharmacy Dan Fivey Personal Training Abbeyfield Gloucestershire Society Cheltenham Chiropractic Clinic Ltd
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93 St George's Road, Cheltenham, Gloucestershire, GL50 3ED
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Your Neighbourhood Professionals. Just a Click Away! Oakhaven Residential Care Home Badham Pharmacy Dan Fivey Personal Training Abbeyfield Gloucestershire Society Cheltenham Chiropractic Clinic Ltd
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