General Health Questionnaire

Please complete the following questions to allow us to update your records.

Last Updated: 03/12/2020

  • Your details

  • Your Profile

    To calculate your BMI please copy and paste the following link into a new tab. Once you have calculated your BMI please input the results below. https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/

  • Blood Pressure

    If you have a home blood pressure monitor please record an up to to date reading

  • Your Lifestyle - Alcohol

    Please answer the following questions which are validated as screening tools for alcohol use. Units ( 1 Unit = 1/2 Pint, 1 small glass of wine, 1 measure of spirit. 2 Unit = 1 pint of beer, larger or cider, 1 medium glass of wine. 9 Units = 1 bottle of wine)

    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 have you had 6 or more units if female , or 8 if male, on a single occasion in the last year?

  • A score less than 5 indicates lower risk drinking. Scores of 5 or more requires the following 7 questions to be completed.

    How often during the last year have you found that you were not able to stop drinking once you have started? (optional)
    How often during the last year have you failed to do what was normally expected from you because of your drinking? (optional)
    How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session? (optional)
    How often during the last year have you had a feeling of guilt or remorse after drinking? (optional)
    How often during the last year have you been unable to remember what happened the night before because you had been drinking? (optional)
    Have you or somebody else been injured as a result of your drinking? (optional)
    Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down? (optional)

  • Your Lifestyle - Smoking

    Do you smoke?
    Do you use an E-Cigarette?
    How many cigarettes did/ do you smoke a day? (optional)
    Would you like help to quit smoking? (optional)

  • Advice and Support Contacts

    If you would like to seek advice or support for to help improve your lifestyle such as; smoking, alcohol and weight management please visit the Health Advice page on our website. https://www.constablecountrymedicalpractice.co.uk/patient-advice

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