If you require a COPD review you can either complete the form below or download the review form (DOCX, 22KB) (and return the completed form to the surgery).
Do you want to stop smoking? Here is some advice on ways to quit smoking, local services and general tips: www.nhs.uk/smokefree
Thank you for completing this questionnaire. Your practice will review this information in the next 28 days and be in touch if further action is required. If you are concerned or worried about your symptoms, please book a COPD review appointment.
Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to Shotfield Medical Practice • Shotfield, Wallington, Surrey, SM6 0HY.
Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.
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