Long term condition questionnaire

Use this service to complete a routine review of your long term condition(s).

You can use this service if you:

• are registered at the surgery

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of

We request that you complete this questionnaire at least 3 days before your Long Term Condition Appointment with one of our HCAs. This provides us with up to date health information allowing us to make better use of the time spent with our clinicians and ensure you have the most appropriate appointment.

If you do not have a Blood Pressure (BP) machine at home, you can have your BP, height and weight measured at your local community pharmacy. You can also use the SurgeryPOD in the Brookside Surgery waiting room and complete the Long Term Condition Questionnaire instead of completing this form. Again, please use the SurgeryPOD at least 3 days before your appointment.

How would you like to provide your blood pressure information?

I have 7 days of blood pressure readings (Preferred) I have a one off Blood Pressure reading

You can also phone us on Brookside Surgery 0118 966 9333 or Chalfont Surgery or Winnersh Surgery or Wilderness Road Surgery .