45 Princess Street,
Chadsmoor, Cannock,
Staffordshire, WS11 5JT

Patient Health Questionnaire

To help us keep your medical record up to date, we would be grateful if you would take a few minutes to complete our Health Questionnaire. The information requested is basic and is of course confidential.

Additionally, the Department of Health has asked all General Practices to ascertain the smoking habits of their patients so that services and resources can be directed to those patients wishing to quit.

It is therefore important that patients completing these forms confirm whether or not they are a current smoker, a past smoker or have never smoked tobacco.

If you do not wish to complete the Health Questionnaire online, please contact us and we will arrange a paper copy to be sent to you.

Complete a Health Questionnaire