General Health Questionnaire

Section

Ethnicity

Please specify the ethnic group you consider you belong to: *
*
*
*
*
*

Blood Pressure

Smoking

Smoking Status: *
Would you like help to give up smoking?

Alcohol Consumption

One unit of alcohol

Amount of different types of drink representing one unit of alcohol

More than one unit of alcohol

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

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? *

If you have any health concerns that are not related to your long term condition please contact the surgery and arrange an appointment or contact 111.