Warfarin This Warfarin questionnaire will help your healthcare provider determine if we need to review your Warfarin dose Please tell us which practice you are registered with—Please choose an option—Haigh Hall Medical PracticeShipley Medical PracticeSunnybank and Cowgill PracticeThe Willows, Thornton and Denholme Medical Practice Full name NHS Number Date of Birth Email address Phone What is your INR? Is this in range for you? YesNo Have you experienced any bleeding? YesNo Have you experienced any bruising? YesNo Have you missed any doses in the last week? YesNo Have you had any changes to medication, diet, pain killers or alcohol consumption? YesNo If you answered yes to the last question, please give further details? What is your current daily dose of warfarin? How many test strips do you have left? What is the expiry date of your test strips?