PATIENT DATA UPDATE

Personal Details

Please indicate your ethnicity:

Please indicate your ethnicity:

Are you a military veteran?

Are you a military veteran?

If you have served in the UK Armed Forces, please indicate which service. (For Reservists/Territorial Army please confirm if you have served as a regular service personnel for more than one day e.g., deployed on operations (OP HERRICK etc), please indicate which service you were deployed with.

For this we mean spouse or daughter/son (please specify)

Smoking habits?

Smoking habits?

If you are a smoker, would you like some advice on giving up?

If you are a smoker, would you like some advice on giving up?


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