Diabetes Review

If you have been advised by the practice to submit a diabetes review, please use this form.

Diabetes Review

Smoking Review

Do you currently smoke? *
Have you smoked in the past? *

Blood Pressure Review

If you have your own blood pressure machine, please enter two readings below.

For details about measuring blood pressure at home and blood pressure machines please visit our  Blood Pressure Review Form.

If you do not have a machine, please come to Reception to have your blood pressure and weight checked on the Practice machine.

Calculate my BMI

I have my measurements in:
eg. 1.75
e.g 60.6

If your measurements are in Feet and inches/ stones and pounds, please visit NHS UK: BMI Calculator.

Once your BMI has been calculated, please enter this in the box below.

Foot Check

How often do you check your feet? *
Have you had any problems or noticed any changes like cuts, blisters, broken skin, corns? *
Please select which foot:
Have you had any pain or discomfort in your feet? *
Please select which foot:
Do you have any cramp-like pains when walking? *
Please select which foot:

Eye Check

Have you had a hospital diabetic eye check in the last 12 months? *

Completing Your Diabetes Checks

To complete your checks, please collect a urine test form and sample pot form at reception. This is another way of monitoring your kidney function.

Please also collect a blood test form at reception if you have been requested to do so.