Diabetes review

You have been invited by the surgery to complete this form to help the staff review your Diabetes. Please complete the following, allowing up to 4 weeks for your review to be completed.

Do you feel your health is affecting your mood?

Yes

No

As part of this review process we require you to have your bloods taken, a urine sample checked and vital measurements performed. Around a week later, we will arrange a follow up appointment with the Nurse.

Appointments required:

Health Care Assistant appointment – if possible, please bring a urine sample to this appointment, and Diabetes review with Nurse

Please tell us when you are available to have appointments in the next 3 weeks:

If there is anything else you need to share with us regarding your Diabetes please do so below:

*

I understand that the practice may need to send me a secure online message about my appointment. I will check my emails.

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