NHS Health Check

Section

NHS Health Checks are for adults in England aged 40-74 without a pre-existing condition. The pre-existing conditions not eligible for an NHS Health Check are:

Coronary Heart Disease
Chronic Kidney Disease Stages 3,4 and 5
Diabetes
Hypertension
AF
Stroke/TIA
Hypercholesterolaemia
Heart Failure
Peripheral Arterial Disease or already taking statins

Please be aware that you will require a blood test with our phlebotomist prior to any nurse appointment for an NHS Health Check - without reviewing these results we are unable to complete the check.

Have you already booked an appointment or are you booking an appointment with the phlebotomist for NHS Health Check bloods? *

Yes

No

Please book an appointment with the phlebotomist for NHS Health Check bloods.

Without reviewing these results, we are unable to complete the check.

Diet

Please select one of the following statements that describes your diet: *

Exercise

Please select one of the following statements that describes your physical activity: *

I am inactive

I am moderately inactive

I am moderately active

I am active

General Practice Physical Activity Questionnaire

Please tell us the type and amount of physical activity involved in your work: *

I am not in employment (e.g. retired, retired for health reasons, unemployed, fulltime carer etc.)

I spend most of my time at work sitting (such as in an office)

I spend most of my time at work standing or walking. However, my work does not require much intense physical effort (e.g. shop assistant, hairdresser, security guard, childminder, etc.)

My work involves definite physical effort including handling of heavy objects and use of tools (e.g. plumber, electrician, carpenter, cleaner, hospital nurse, gardener, postal delivery workers etc.)

My work involves vigorous physical activity including handling of very heavy objects (e.g. scaffolder, construction worker, refuse collector, etc.)

During the last week, how many hours did you spend on each of the following activities?

Physical exercise such as swimming, jogging, aerobics, football, tennis, gym workout etc. *

None

Some but less than 1 hour

More than 1 hour but less than 3 hours

3 hours or more

Cycling, including cycling to work and during leisure time *

None

Some but less than 1 hour

More than 1 hour but less than 3 hours

3 hours or more

Walking, including walking to work, shopping, for pleasure etc. *

None

Some but less than 1 hour

More than 1 hour but less than 3 hours

3 hours or more

Housework/Childcare *

None

Some but less than 1 hour

More than 1 hour but less than 3 hours

3 hours or more

Gardening/DIY *

None

Some but less than 1 hour

More than 1 hour but less than 3 hours

3 hours or more

How would you describe your usual walking pace? *

Slow pace (i.e. less than 3 mph)

Brisk pace

Steady average pace

Fast pace (i.e. over 4mph)

Alcohol Consumption

This is one unit of alcohol:

Amount of different types of drink representing one unit of alcohol

And each one of these, is more than one unit:

Amount of different types of drink representing more than one unit of alcohol

How many units of alcohol do you drink a week? *

Smoking Status

Are you a smoker? *

Yes

No

How many do you smoke a day? *

Family Medical History

Has a member of your immediate family (father, mother, siblings, and grandparents) had or suffered from a heart attack? *

Yes

No