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.


For example, a family home, a residential care home, your own home, supported living.

Select as many as you wish

This could be children, parents or partner.

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)

Select as many as needed

Privacy Protection

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.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.