Health Check for People with a Learning Disability
Please complete this form before you see the doctor.
When you come to see the doctor please being all of your medicines with you.
Do you have any problems with any of the following:
Do you see any of the following health professionals?
Other Health Questions
For men and women aged 60-69
For men (all ages)
For women (all ages)
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure
connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.