Annual Diabetic Review Appointment Request

Boroughbury Medical Centre > Your Health > Health Review Forms > Annual Diabetic Review Appointment Request

We would usually ask you attend for your annual Diabetic review in your birthday month (but if you are born in Jan-March we would prefer you attend in June-August)

Please let us know preferred dates and times and whether you can attend Craig Street or Werrington.

Your Annual Diabetic Review is important. Find out more about managing diabetes.

Annual Diabetic Review Request

First Name *

Last Name *

Email *

Enter Email

Confirm Email *

Confirm Email

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Where would you prefer to have the test

Craig Street (Main site) : Monday-Friday 0830-1700

Werrington (branch site): Mon-Friday 0830-1700

Please provide any additional information, including preferred dates or times

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

I consent to the practice collecting and storing my data from this form.

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Annual Diabetic Review Appointment Request

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