Prostate Tests

For further information about prostate symptoms and PSA screening please see here. As PSA testing alone is not considered sufficient screening for symptomatic men we recommend discussing with GP first.

Dedridge Medical Group > Your Record > Chronic Disease Management > Cardiac Review Form

Cardiac Review Form

Please complete this form if you have been asked to do so as part of your annual monitoring. If you do not have access to a home monitor, we have a self check BP machine in the waiting area which you may use without an appointment.

Please also remember to book an appointment for bloods if you have not had any within the last year (lipids and glucose).

More information about your heart condition can be found at The British Heart Foundation.

Cardiac Review

First Name *

Last Name *

Email *

Enter Email

Confirm Email *

Confirm Email

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

What is your blood pressure ? *

What is your weight? *

Do you smoke? *

Yes

How active are you? *

Are you having any symptoms related to your heart condition that you are concerned about?

If you take GTN spray or tablets how often are you using these?

Are you having any side effects from your medication? *

Yes

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.

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

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