Ethnicity Data

If you need to or have been asked by the surgery to provide your ethnicity information, please submit this form.

Ethnicity Data

Ethnicity Data

Section

Ethnicity

Please specify the ethnic group you consider you belong to: *

About the Patient

Smoking

Smoking Status:
Would you like advice for quitting?

Alcohol Consumption

This is one unit of alcohol:

Amount of different types of drink representing one unit of alcohol

And each one of these, is more than one unit:

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