NHS Health Check

Section

NHS Health Checks are for adults in England aged 40-74 without a pre-existing condition. The pre-existing conditions not eligible for an NHS Health Check are:

  • Coronary Heart Disease
  • Chronic Kidney Disease Stages 3,4 and 5
  • Diabetes
  • Hypertension
  • AF
  • Stroke/TIA
  • Hypercholesterolaemia
  • Heart Failure
  • Peripheral Arterial Disease or already taking statins

Please be aware that you will require a blood test with our phlebotomist prior to any nurse appointment for an NHS Health Check – without reviewing these results we are unable to complete the check.

Have you already booked an appointment or are you booking an appointment with the phlebotomist for NHS Health Check bloods? *

Please book an appointment with the phlebotomist for NHS Health Check bloods.

Without reviewing these results, we are unable to complete the check.

Diet

Please select one of the following statements that describes your diet: *

Exercise

Please select one of the following statements that describes your physical activity: *

General Practice Physical Activity Questionnaire

Please tell us the type and amount of physical activity involved in your work: *
During the last week, how many hours did you spend on each of the following activities?
Physical exercise such as swimming, jogging, aerobics, football, tennis, gym workout etc. *
Cycling, including cycling to work and during leisure time *
Walking, including walking to work, shopping, for pleasure etc. *
Housework/Childcare *
Gardening/DIY *
How would you describe your usual walking pace? *

Alcohol Consumption

This is one unit of alcohol:

Amount of different types of drink representing one unit of alcohol

And each one of these, is more than one unit:

Amount of different types of drink representing more than one unit of alcohol

Smoking Status

Are you a smoker? *

Family Medical History

Has a member of your immediate family (father, mother, siblings, and grandparents) had or suffered from a heart attack? *
Has a member of your immediate family (father, mother, siblings, and grandparents) had or suffered from a stroke? *
Has a member of your immediate family (father, mother, siblings, and grandparents) had or suffered from cancer? *
Has a member of your immediate family (father, mother, siblings, and grandparents) had or suffered from diabetes? *
Has a member of your immediate family (father, mother, siblings, and grandparents) had or suffered from high blood pressure? *
Has a member of your immediate family (father, mother, siblings, and grandparents) had or suffered from any other illness/disease? *

Blood Pressure

Do you monitor your blood pressure at home? *
Please give us your latest blood pressure reading:

Weight

Do you monitor your weight regularly at home? *

A member of the practice nursing team will review your form and get in contact via telephone at their earliest convenience.

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