Height and Weight Recording

This form collects your height and weight, for addition to your GP medical record.

Last Updated: 20/01/2020

Your Details

We ask for this information to check that you are a patient at this practice and to identify the correct GP record to include your information

Name *

Date of Birth *

What is the first line of your home address? *

Mobile Number

Email Address

Height and Weight Please

Please tell us your height (in feet and inches, or centimetres please) *

Please give your weight (in Stones and pounds or Kilos please) *

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 *

I consent to the practice collecting and storing my data from this form.

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Height and Weight Recording

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