Updating your medical records online Contact Us OnlineWant to make sure your basic information is correct on your medical records? If yes fill out our online form below. Please complete the online form below to update your clinical records. Title Mr Mrs Miss Ms Mx Dr Other First Names Surname Date of Birth Day Month Year Address Street Address Address Line 2 City Postcode Home Phone Number OptionalMobile Phone Number OptionalEmail Enter Email Optional Confirm Email Optional What is your ethnicity? English / Welsh / Scottish / Northern Irish / British Optional Irish Optional Gypsy or Irish Traveller Optional Any other White background Optional White and Black Caribbean Optional White and Black African Optional White and Asian Optional Any other Mixed / Multiple ethnic background Optional Indian Optional Pakistani Optional Bangladeshi Optional Chinese Optional Any other Asian background Optional African Optional Caribbean Optional Any other Black / African / Caribbean background Optional Arab Optional Any other ethnic group Optional Are you allergic to any medications? (please state which ones) Optional Height and WeightHeight Optional (In Feet & Inches OR cm)Weight Optional (In stone & lbs OR kg)SmokingHave you ever smoked tobacco? Yes Optional No Optional If you are currently a smoker and would like to stop please contact the surgery to discuss this further.AlcoholHow often do you have a drink containing alcohol? Never Optional Once a month or less Optional 2 to 4 times a month Optional 2 to 3 times a week Optional 4 or more times a week Optional (1 drink = 1/2 pint of beer or 1 glass of wine or 1 single spirits)How many standard drinks containing alcohol do you have on a typical day when drinking? 0 Optional 1 or 2 Optional 3 or 4 Optional 5 or 6 Optional 7 to 9 Optional 10 or more Optional 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.Are you a Carer? Yes Optional No Optional Additional Notes Optional