Health Questionnaire

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Alcohol Guidelines

Alcohol Within Guidelines
  • No more than 10 (women) 15 (men) standard* drinks per week
  • At least 2 alcohol free days per week
  • Not drinking more that 6 alcoholic drinks on one occasion

*one standard drink of alcohol = 100 ml wine (12.5%) one 330ml can of beer (4%) or one 30ml shot of spirit

Do you have any allergies (e.g. medications, food, latex, pollen)?
Have you had a tetanus vaccination?
Have you had a COVID vaccination?
Do you require an interpreter service for your medical appointments?

Do you have a family history of:

Heart Disease