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East Norwich Medical Partnership NHS GP Surgery in Norwich

Ethnicity data

Ethnicity Data

Section

Ethnicity

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

White British

White Irish

Black Caribbean

Black African

Black Caribbean and White

Black African and White

Asian and White

Chinese

Indian

Pakistani

Bangladeshi

I do not wish to state

Other ethnic group

Please specify: *

About the Patient

Height:

Weight:

Smoking

Smoking Status:

Smoker

Ex Smoker

Never Smoked

How many do you smoke per day?

Would you like advice for quitting?

Yes

No

How many did you smoke per day?

When did you quit?

Alcohol Consumption

This is one unit of alcohol:

Amount of different types of drink representing 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 alcohol

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

How many units do you consume per week?

If you are human, leave this field blank.

Sprowston Primary Care Centre
Aslake Close
Sprowston
Norwich
NR7 8DG

Get directions

01603 778277

Thorpe Health Centre
St. Williams Way
Thorpe St. Andrew
Norwich
NR7 0AJ

Get directions

01603 778277

About the surgery

Register with the surgery

Sick (fit) notes

Feedback and complaints

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