UPDATING YOUR CLINICAL RECORD
It is very important that we keep your Clinical Record up to date as this is used by our clinicians when making clinical decisions about your care and treatment. Please complete this form and we will update your records accordingly.
Update your Clinical Records
PHYSICAL ACTIVITY QUESTIONNAIRE
Please answer the questions in the short questionnaire to enable us to assess your physical activity and offer advice if necessary.
Physical Activity Questionnaire
ALCOHOL CONSUMPTION QUESTIONNAIRE
Please answer the questions in the short questionnaire to enable us to assess your alcohol consumption rate and offer advice if necessary.
Alcohol Consumption Questionnaire
DEPRESSION ASSESSMENT QUESTIONNAIRE
This easy to use patient quesionnaire has been validated for use in Primary Care. It is used by your doctor to monitor the severity of depression and response to treatment. It can also be used to make a tentative diagnosis of depression.
PHQ-9 Depression Assessment Questionnaire
MEASURE OF SHORTNESS OF BREATH CLASSIFICATION
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CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) QUESTIONNAIRE
For patients who are due a COPD review
We offer all of our COPD patients an annual review. It may not be necessary for you to attend the surgery for this review. We will ask you to complete a questionnaire, which is available from the surgery, or from the link below.
Please would you answer the questions on the form below and return it to the practice either by post, email or in person at reception.
If your symptoms are deteriorating or you have any concerns, please make an appointment with the respiratory nurse.
Charlton Medical COPD Review Questionnaire
ASTHMA QUESTIONNAIRE
For patients who are due an annual asthma review
We offer all of our Asthma patients an annual review. It may not be necessary for you to attend the surgery for this review. We will ask you to complete a questionnaire, which is available from the surgery, or from the link below.
Please would you answer the questions on the form below and return it to the practice either by post, email or in person at reception.
If your symptoms are deteriorating or you have any concerns, please make an appointment with the respiratory nurse.
Charlton Medical Asthma Review Questionnaire