Patient Health History Questionnaire

Personal Information

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Welcome to our Patient Health History questionnaire.

This questionnaire is designed to help us understand your medical history, lifestyle habits, and family history, so we can provide you with the best possible care.

Your answers will be kept confidential and will only be used to inform your healthcare team.

Please take the time to answer each question thoughtfully and accurately.

Your participation in this survey is greatly appreciated and will help us to provide you with personalised care that meets your unique health needs.

Thank you.

1. Please complete the following: