Annual Health Review

Please only use this form if you have been sent an invitation (text or letter) for your annual review. We invite all our patients who have a long term condition to have an annual health review, usually around their birthday month.

You may need to have a blood test and blood pressure check before the review, but we will let you know if this is the case. The review will take place by telephone with a member of the long term conditions team.

Annual Health Review

Annual Health Review



1. Physical activity at work

Please tell us the type and amount of physical activity involved in your work, tick the box that is most relevant to you:

2. Physical Exercise

During the last week, how many hours approximately did you spend on each of the following activites? Please state amount in each box:


How would you say you diet is from Good, Average, or Poor?


Do you currently smoke tobacco?
Have you ever smoked?
Do you currently smoke an e-cigeratte/vape?

Alcohol Screening

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 or more if male, on a single occasion in the last year? *

Have you received an invitation (letter or text) to book this Annual Health review? *