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Diabetes Review Form

Here is a new way of reviewing people with type 2 diabetes. You will need to collect data like height, weight and blood pressure readings then complete the form below. Please do not complete this form until you have collected this information.   

We will contact you to arrange any monitoring bloods and foot checks that may be needed. 

Once we have collected all your results our team will call or video call to discuss your care and medication in the following few weeks. You will not need to attend the surgery as often. The only equipment you need to use this new service is a home blood pressure machine.

Further information about Type 2 Diabetes from NHS UK

Please select the preferred version of the Home Blood Pressure Diary Form. Once completed please upload the BP sheet containing your week’s blood pressure readings. Alternatively you can submit the online Blood Pressure review form with your readings.

Diabetes Review
Enter Email
Please use format day/month/year e.g. 12/05/1979

Your Height and Weight

Weight

Unit of measurement *
cm
kg
ft
in
lbs

BMI

Underweight
Healthy
Overweight
Obese

Diabetes Review

Maximum upload size: 5MB
We accept jpeg, gif, png, tif, pdf, and word files up to 5MB.
Do you smoke? *
How active are you? *
Could you eat more healthy? *
Do you drive? *
Are you having problems with your feet? *
One of our clinicians will contact you on this number in the next couple of weeks.
e.g. problems with mood or erectile disfunction

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.