Update your clinical record

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Personal Details

Do you consent to being contacted by email: *

Do you consent to being receiving messages by text: *

Text messages are a useful way for the practice to communicate information to patients, for example: appointment reminders, invitations and other alerts.

Ethnicity & Religion

Please specify the ethnic group you consider you belong to: *

Do you need an English translator?:

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Your Health

Do you have any allergies we should be aware of?: *

Smoking Status: *

Assistance is available free of charge through the NHS should you wish to receive advice on giving up smoking

QUIT SMOKING

Do you have a home blood pressure monitor: *

Are you taking any medication that you do not have on prescription?: *

Do you have a carer?: *

Are you a carer? : *

Do you require information in a different format? : *

eg large print

Do you have any mobility problems?: *

Do you have any hearing problems?: *

Do you have any sight problems?: *

Group Consultations

We will be offering an exciting new way of offering annual reviews and support for chronic diseases (eg COPD, Diabetes). These are one to one consultations but delivered as part of group setting. Patients can learn from one another and gain valuable insight into their condition from another patients experience whilst also benefiting from more time with the clinician.

Would you be interested in joining a group consultation: *

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Your Personal Alcohol Consumption

1 unit of alcohol

How often do you have a drink containing alcohol?: *

How many units of alcohol do you drink on a typical day when you are drinking?: *

How often do you have 8 or more units on one occasion?: *

Your Personal Alcohol Consumption - Part 2

How often during the last year have you found that you were not able to stop drinking once you had started?: *

How often during the last year have you failed to do what was normally expected from you because of your drinking?: *

How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?: *

How often during the last year have you had a feeling of guilt or remorse after drinking?: *

How often during the last year have you been unable to remember what happened the night before because you had been drinking?: *

Have you or somebody else been injured as a result of your drinking?: *

Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?: *

Audit Score Result 0 - 7 (Lower Risk)

Low Risk - you have a score of ()

Your answers suggest you are at a lower risk of being dependent on alcohol.

If you are drinking less than 14 units of alcohol per week, then your drinking is within the UK Chief Medical Officers' low risk drinking guidelines.

But if you are drinking regularly at or above the low risk guidelines of 14 units a week, or, you are drinking six or more units - if you are female - or eight or more units - if you are male - in one single session (binge drinking), please consider the increased serious risks to your health being caused by your current drinking pattern.

Audit Score Result 8 - 15 (Increasing Risk)

( Increasing Risk ) - you have a score of ()

Your answers suggest you are at an increasing risk of being dependent on alcohol.

Your drinking is dangerous to your health, increasing your risk of serious health problems including seven types of cancer, liver and heart disease, and high blood pressure. Unless you cut down you are at risk of damaging your health.

Audit Score Result 16 - 19 (Higher Risk)

(( Higher Risk )) - you have a score of ()

Your answers suggest you are at Higher Risk of being dependent on alcohol.

Your drinking is dangerous to your health. You are drinking far more than the UK Chief Medical Officers' low risk drinking guidelines of 14 units a week. Regularly drinking this much causes a range of serious health harms including seven types of cancer, liver disease and high blood pressure.

Audit Score Result 20+ (Possible Dependence)

(( Possible Dependence )) - you have a score of ()

Your answers suggest you are at High Risk of being dependent on alcohol.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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CONTACT DETAILS

Station Medical Centre
Station Approach, Hereford, HR1 1BB

South Wye Medical Centre
Asda Superstore, Belmont Road, Hereford, HR2 7JE

Bobblestock Surgery
Grandstand Road, Hereford, HR4 9LP

All incoming and outgoing phone calls to the Practice are recorded for training and monitoring purposes.

CONTACT DETAILS

Quay House Medical Centre
100 Westfaling Street, Hereford, HR4 0JF

Credenhill Surgery
16 Meadow Drive, Hereford, HR4 7EF

Tel: 01432 272 175
Out Of Hours: 111

PRACTICE POLICIES

Find out more about the policies and procedures we adhere to at Hereford Medical Group

VIEW OUR POLICIES

Update your clinical record

Group Consultations

Low Risk - you have a score of ()

( Increasing Risk ) - you have a score of ()

(( Higher Risk )) - you have a score of ()

(( Possible Dependence )) - you have a score of ()

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CONTACT DETAILS

CONTACT DETAILS

PRACTICE POLICIES

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