Update My Records

You can help us to keep our records current and accurate. Please complete the short online form below to update your records.

Update My Records

Please complete the form to update your existing records with Forum Health Centre.
Any field marked with * is mandatory

Name and address

Title
First Name*
Last Name*
Date of Birth*
Address Line 1
Address Line 2
Town
County
Postcode

Contact details

Home Phone Number
Mobile Number
Work Number
Email Address*
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Clinical details

Height
Weight
Blood Pressure

Smoking

Do you smoke?
Never
Current smoker
Ex-smoker
Date stopped smoking

Drinking alcohol

How often do you have a drink containing alcohol?

How often?

How many units of alcohol do you drink on a typical day when you are drinking?

Units on a typical day?

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?

Units on a single occasion?

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