Update my health records Information To update your records you can either fill out the below form or you can also email, call or come into the practice - just ask Reception. If you are registered to Patient Access you can update your contact details from there directly quickly and easily. Name: * Address: * Date Of Birth: * (DD/MM/YYYY) Mobile Phone: Home Phone: Email Address: Would you be happy for the practice to contact you via SMS text messaging regarding outstanding routine reviews or tests relating to your health? Yes No Would you be happy for us to contact you via Email with information regarding routine health checks and other practice related news? Yes No Would you be happy for the practice to use your email address for you to take part in future patient participation surveys? Yes No Height (In Feet & Inches or cm) Weight (In stone and lb or kg) How many units of alcohol do you drink in an average week? How often do you have a drink containing alcohol? Never Monthly or Less 2 - 4 Times Per Month 2 - 3 Times Per Week 4 Or More Times Per Week How many drinks containing alcohol do you have on a typical day when you are drinking? 0 - 2 3 - 4 5 - 6 7 - 9 10 or more How often do you have 6 or more units on one occasion? Never Less Than Monthly Monthly Weekly Daily Or Almost Daily Have you ever smoked? Yes No Do you smoke now? Yes No if "Yes" how many do you smoke each day? If "No" when did you quit?