Heath Hayes: 01543 278 461  Chase Medical: 01543 577 972  Out of Hours: 111

Heath Hayes Health Centre
Gorsemoor Road, Heath Hayes, Cannock, WS12 3TG
Chase Medical Practice
65 Church Street, Cannock, WS11 1DS

Patient Health Questionnaire

To help us keep your medical record up-to-date, we would be grateful if you would take a few minutes to complete our Health Questionnaire. The information requested is basic and is of course confidential.

Additionally, the Department of Health has asked all General Practices to ascertain the smoking habits of their patients so that services and resources can be directed to those patients wishing to quit.

It is therefore important that patients completing these forms confirm whether or not they are a current smoker, a past smoker or have never smoked tobacco.

If you do not wish to complete the medical records update online, please contact us and we will arrange a paper copy to be sent to you.

Thank you.

Complete a Patient Health Questionnaire.