Hypothyroid Self Assessment

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

If you are human, leave this field blank.

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Phone Number:

Email Address: *

Weight: *

Pulse: *

If it is less than 60 or above 80 when resting please discuss this with your doctor

Change in Weight:

Abnormal weight gain

Abnormal weight loss

About stable weight

Have you had your blood tested for thyroid in the last 9 months? *

Yes

I can't remember

Important -

We are delighted to announce that Corinthian Surgery and Portland Practice merged successfully on 1st July 2021. The same doctors, practice nurses and staff will still be part of ... Find out more

Important -

Booking Appointments from 6th July 2021. In late May we published advance notification of the intention to adopt the 'eConsult' process for making appointments once Corinthian Sur... Find out more

Important -

We are delighted to announce our intention to merge with the Portland Surgery on 1st July 2021. Following discussion with GPs and staff at the Portland Surgery about our strength... Find out more

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Hypothyroid Self Assessment

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