Neasham Road Surgery
186 Neasham Road Darlington County Durham DL1 4YL
Tel: 01325 461128
Fax: 01325 469123
Out of Hours: 111

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Update Your Clinical Record Online

Update Your Clinical Record Online

Please complete the form below to update your clinical record.

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    Pick a date.
  • If you do not have a home telephone number please enter your main contact telephone number here instead.

  • Height & Weight

  • Smoking

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    Pick a date.
  • Alcohol

    One alcohol unit is measured as 10ml or 8g of pure alcohol. This equals one 25ml single measure of whisky (ABV 40%), or a third of a pint of beer (ABV 5-6%) or half a standard (175ml) glass of red wine (ABV 12%).

  • Depression

  • Please answer the following questions:
      Not at all Several days More than 1/2 the days Nearly every day
    Have you found little pleasure or interest in doing things?
    Have you found yourself feeling down, depressed or hopeless?
    Have you had trouble falling or staying asleep, or sleeping too much?
    Have you been feeling tired or had little energy?
    Have you had a poor appetite or been overeating?
    Have you felt that you're a failure or let yourself or your family down?
    Have you had some trouble concentrating on things like reading the paper or watching TV?
    Have you been moving or speaking slowly, or very fidgety, so that other people could notice?
    Have you thought that you'd be better off dead or hurting yourself in some way?
  • Carer

    A carer is someone who looks after an elderly person or someone who is disabled. We do not mean a carer of a child.

  • Other Information

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