Stroke / TIA Review

Your Health

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
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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? *

Have you had a flu vaccination in the last year? *
Are you taking any anti-coagulant (e.g. Warfarin) or anti-platelet (e.g. Aspirin) medications? *
*