Medical Information Update

Monitoring Information Update Form

Some medicines require regular monitoring to help us make sure they are still safe and suitable for you. In some cases, you may not need to attend the surgery in person, as you may be able to provide some of this information from home.

This form allows you to send us simple health information, such as your height, weight, blood pressure, pulse, and smoking status. Providing this information helps us keep your medical record up to date and may reduce the need for a face-to-face appointment where it is clinically appropriate to do so.

Please complete this form as fully and accurately as you can. It should only take a few minutes.

Before you start, please make sure you have your details ready, including your first name, last name, date of birth, and address, so we can match the information to your medical record correctly.

Name Required

First Last

Date of Birth Required

Address Optional

Street Address Optional Address Line 2 Optional City Optional Postcode Optional

Height and Weight

Please provide your height and weight as accurately as possible.

Height

Please enter your height in centimetres if possible. If you only know your height in feet and inches, you can enter that if the form allows.

Weight

Please enter your weight in kilograms if possible. For the best accuracy, weigh yourself on a flat, hard surface, ideally at a similar time of day, in light clothing and without shoes.

What is your current height? Required

What is your current weight? Required

Blood Pressure and Pulse

Please provide your blood pressure reading as accurately as possible. Blood pressure is recorded as two numbers:

Systolic – the top number
Diastolic – the bottom number

For example, if your reading is 128/78, the systolic reading is 128 and the diastolic reading is 78.

If possible, please take your reading when you are sitting down and relaxed. Sit quietly for 5 minutes before taking the reading, rest your arm on a table, keep your feet flat on the floor, and avoid talking during the measurement. Avoid caffeine, smoking, or exercise for 30 minutes beforehand if possible.

If you take more than one reading, please take 2 readings 1 to 2 minutes apart and enter the second reading, unless you have been advised otherwise.

Pulse Rate

Your pulse rate is the number of heartbeats per minute. You may get this from your blood pressure monitor, a smartwatch, or by counting your pulse manually while resting.

Systolic Required

Diastolic Required

Pulse Required

Smoking Status

Please select the option that best describes your current smoking status.

I have never smoked
I used to smoke but have stopped
I currently smoke
I use other nicotine products (for example vapes or patches)

If you currently smoke and the form allows, you may wish to include how much you smoke (for example, number of cigarettes per day).

Providing accurate smoking information helps us support your health and ensure your treatment remains appropriate.

Smoking Status Required

Important Information

Please ensure that all information you provide is your own and entered correctly. Incorrect details may delay processing.

This form is for routine monitoring only. It should not be used if you feel unwell, have concerning symptoms, or require urgent medical attention.

If your blood pressure reading is very high, or you feel unwell, please seek medical advice urgently. In an emergency, call 999.

Please note:

Your results are not reviewed instantly
A member of the team will review your information in line with our usual processes
We will contact you if any follow-up is needed

Thank you for helping us keep your records up to date and support your ongoing care.