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Littledown Surgery

Harewood Crescent | Bournemouth | BH7 7BU

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New Patient Short Questionnaire

We would like you to complete this short questionnaire with your blood pressure reading and family history of health conditions.
Short Questionnaire for New Patients
BP Readings and Family Medical History
Name
Date of Birth
Please enter your readings in the box as follows: xxx/xx Systolic = top reading Diastolic = bottom reading
Email

Family History of Health Conditions

Diabetes
Stroke / TIA
High Blood Pressure (Hypertension)
Asthma
Glucoma
Cancer
Heart Attack
Appointments

Doctor and Nurse Appointments

Home Visits

How to Register with Us

New Patient Short Questionnaire

Out of Hours

Your GP Appointments: Top Tips

Emergencies / Urgent Appointments

If you need to be seen the same day please telephone us as soon as possible after 8:30am. If your problem requires urgent assistance please make this clear to the Receptionist.

Infectious Disease

If you have a suspected infectious disease, please inform reception if you suspect an infectious disease, as this will enable us to deal with it appropriately during your visit to protect you, other patients and staff.

Consultations for 16 to 75 year olds

If a patient aged between 16 and 75 years has not had a practice consultation within a period of three years, we are happy, on request, to provide a consultation.