Diabetic Review

If you have been advised by the surgery to submit a diabetic review, please use this form. However, if your diabetes is not under usual control, please contact the surgery to make an appointment with your doctor.

Useful websites for more information about diabetes:

Diabetic Review

About You

Please use this date format: DD/MM/YYYY.

Blood Glucose Readings

Please complete the form below with readings as appropriate. Not all columns need to be filled in, your diabetes nurse can advise you how often these should be done.

Day 1

Please use this date format: DD/MM/YYYY.

Day 2

Please use this date format: DD/MM/YYYY.

Day 3

Please use this date format: DD/MM/YYYY.

Day 4

Please use this date format: DD/MM/YYYY.

Day 5

Please use this date format: DD/MM/YYYY.

Day 6

Please use this date format: DD/MM/YYYY.

Day 7

Please use this date format: DD/MM/YYYY.