Diabetes Review

If you have been advised by the surgery to submit an annual review of your diabetes symptoms please use this form. If your symptoms are deteriorating or you are having any concerns please make an appointment with our Nurse.

Diabetes Review

Diabetes Review


Please give this measurement in Meters.
Please give this measurement in KG.
Please give a days average.

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
Smoking Status:

If you are a current smoker we strongly advise you to stop smoking. The practice runs a Smoking Cessation Clinic offering support and advice. An appointment can be made by contacting the surgery on 01926 859955.

What level of exercise do you participate in?
How would you describe your diet?
Are you depressed?
Are your feet painful or numb?
Are your feet cold to touch?
Do you suffer with erectile dysfunction?
Do you feel there are problems with your memory?
Are you seeing a podiatrist?
Do you get any lumps at your injections sites?
What ones?
Have you had your annual eye screening?