Stroke Review

If you have been asked by the surgery to complete a Stroke Review, please fill out this form.

Stroke Review

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You have been invited by the surgery to complete this form to help the staff complete your Stroke Review. Please complete the following, allowing up to 4 weeks for your review to be completed.

Do you feel your health is affecting your mood?

Yes

As part of this review process we require you to have your bloods taken and vital measurements checked. Around a week later, we will arrange a follow up appointment with the Nurse.

Appointments required:

Health Care Assistant appointment and Stroke review with Nurse

Please tell us when you are available to have an appointment in the next 3 weeks:

If you have a blood pressure monitor at home, please provide your blood pressure reading:

Systolic (Higher):

Diastolic (Lower):

Heart Rate:

I understand that the practice may need to send me a secure online message about my appointment. I will check my emails.

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Practice Boundary