Student medical questionnaire

Use this service if you are a student and have been asked by the surgery to submit your medical information

You can use this service if you:

• are registered at the surgery
• have been invited to do so

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of

Start now

You can also phone us on Cheltenham Road Surgery 01452 522709 or Highnam Surgery 01452 529699.