Healthy Heart Questionnaire

Your Healthy Heart review is now due. It may not be necessary for you to attend the surgery for this review to be carried out. If requested to do so please complete the following questionnaire and return to the surgery.

 

This questionnaire is for a routine review of your symptoms. If you are experiencing chest pain, severe shortness of breath or other concerning symptoms, please follow your care plan (if you have one) or ring your GP or 999 immediately.

Healthy Heart Questionnaire
Calculating your own Blood Pressure

Please complete this section if you have a blood pressure monitor at home. Otherwise, please leave this blank and skip to the next section.

Ignore the first day of readings (as this was when you were getting used to the monitor) and take an average of the remaining readings. Add up all the top systolic blood pressures & divide by the number of blood pressures done, then repeat with the bottom diastolic blood pressures.

Lifestyle-Smoking
Lifestyle- Alcohol
Further Questions
The Next Step

When you are happy with all of your above answers, please return this questionnaire to your GP Practice. Your completed Healthy Heart Questionnaire will now be reviewed by a Health Care Professional, and we will be in touch again once this has taken place.


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This information is not shared with any third party organisations.

This information is retained for up to 28 days.

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