UPDATE YOUR MEDICAL RECORD

Please complete all the questions below.

Personal Details

Are you a Carer?

Are you a Carer?

Does someone look after you?

Does someone look after you?

Lifestyle

Smoking habits?

Smoking habits?

Alcohol

Please complete the following Audit C test:

Unit definition: 1 Glass of Wine = 1.5 Units, 1 Bottle = 10 Units, 1 Pint of Beer = 3 Units, 1 Spirit Measure = 1 Unit

How often do you have a drink containing alcohol?

How often do you have a drink containing alcohol?
How many units of alcohol do you drink on a typical day when drinking?

How many units of alcohol do you drink on a typical day when drinking?

How often have you had 6 or more units if female, or 8 or more if male on a single occasion in the last year?

How often have you had 6 or more units if female, or 8 or more if male on a single occasion in the last year?

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