Pharmacy Health Check

















    Patient Details


    Health Check Information

    24-hour BP arranged by the Pharmacy?


    Blood Results (Where Available)


    Weight Management

    Advice given about weight management

    Advice about Weight

    Health Education Weight Management

    Patient advised to lose weight

    Weight Management Service Opportunity Signposted

    Is a referral to the Weight Management Service clinically appropriate and agreed by the patient?


    Physical Activity

    In an average week how often do you exercise?

    Note: twenty minutes of vigorous walking counts as one exercise session.

    Brief Intervention for Physical Activity Completed

    Physical Activity Opportunity Signposted

    Is a referral to the Physical Activity Service clinically appropriate and agreed by the patient?


    Smoking

    Do you smoke?

    Smoking Cessation

    Stop Smoking Service Opportunity Signposted

    Is a referral to the Stop Smoking Service clinically appropriate and agreed by the patient?


    General Lifestyle Advice Given

    Any Other Comments