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Dedridge Medical Group > Your Record > Chronic Disease Management > Pre-diabetes Review Form

Pre-diabetes Review Form

Please complete this form as part of your annual review for pre-diabetes. In addition please also book a blood test with our health care assistant. This will allow us to streamline your follow up as necessary and a member of the practice team will be in touch within two weeks.

If you do not have access to a blood pressure machine you can use the self check machine in reception without an appointment or ask for a BP check when attending for bloods.

There is a lot you can do to reduce your risk of developing diabetes. Research shows that lots of small changes together can reduce this risk significantly e.g walking more, losing 5% of your body weight or eating a more Mediterrranean diet. For more information on this and pre-diabetes in general please see here – Pre-diabetes/Diabetes UK/Reduce risk type 2 Diabetes.

Please find information here about group education sessions available which can help you to reduce your risk of developing diabetes. Lets Prevent.

Pre-Diabetes

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 *

Is your blood pressure above 140/80?

Yes

What is your blood pressure? *

As your blood pressure is above 140/80 we would like you to provide readings over 5 days

What is your weight? *

Do you smoke? *

Yes

Would you like smoking cessation advice

Yes

How active are you?

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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