Alcohol Consumption Review Form

If you have any concerns regarding your health please contact the surgery for advice. Do not fill in one of these forms unless advice to by staff member.

Alcohol Consumption Review
Enter Email
Confirm Email
Please use format day/month/year e.g. 12/05/1979

Units of Alcohol

chart showing alcohol units

Your Personal Alcohol Consumption

Your Personal Alcohol Consumption – Part 2

Automatically calculated

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.