Hypothyroid Self Assessment

Patients should only complete this form if advised to do so by a clinician.

Hypothyroid Self Assessment

Hypothyroid Self Assessment

Please use this date format: DD/MM/YYYY.
If it is less than 60 or above 80 when resting please discuss this with your doctor
Change in Weight:
Have you had your blood tested for thyroid in the last 9 months? *