Mental Health Review

Your Health

Are you happy to provide your height and weight? *

BMI

eg. 1.75
eg. 60.6
Please note: BMI calculator is only for patients aged 18 and over.

Blood Pressure

Please provide a blood pressure reading if you have access to a machine.

For a list of validated home blood pressure monitors, visit www.bihsoc.org/bp-monitors or discuss with your pharmacy.

Please use format: DD/MM/YYYY
/

Smoking

Smoking status: *

Smoker

What do you mainly smoke?
How many cigarettes do you smoke in a day? *
How many cigars do you smoke in a day? *
Would you like to give up smoking? *

If you would like help or advice to stop smoking, please visit NHS Quit Smoking.

Ex Smoker

What did you mainly smoke?
How many cigarettes did you smoke in a day? *
How many cigars did you smoke in a day? *

Alcohol Consumption

One unit of alcohol

Amount of different types of drink representing one unit of alcohol

More than one unit of alcohol

Amount of different types of drink representing more than one unit of alcohol

How often do you have a drink containing alcohol? *
How many units of alcohol do you drink on a typical day when you are drinking? *
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year? *

Next Steps

As part of your mental health review, please
request an appointment for a cholesterol blood test and HbA1c blood test.

You will then have a follow up phone call with your GP to complete a care plan and discuss the results of your blood tests.

*