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New Consultation

    Patient of the PracticeNew PatientFirst ContactRe-Contact

    MildModerateSevereUncontrollable

    Medical History

    High or low blood pressureHeart MurmurStrokeParalysis Artificial Heart ValveAnginaAsthma/ BronchitisHay fever or eczemaBrain surgeryNeurological (nerve) diseasesArthritisHIVHepatitis / JaundiceLiver or Kidney diseaseFainting attacks/giddinessBlackouts or epilepsy

    ParacetamolIbuprofenPenicillinMetronidazoleAspirinOther

    AnticoagulantsBisphosphonates for bonesOsteoporosisOther

    YesNo

    Are You A Smoker?
    YesNo
    Are You A Drinker?
    YesNo

    Covid-19 Risk Assessment

    Any new continuous cough?
    YesNo
    Temperature above 37.8°C?
    YesNo
    Shortness of breath?
    YesNo
    Self-isolating/has symptoms/anyone in family has symptoms/living with a Covid-19 positive person indoors/over 70 years old/has one or multiple underlying medical history risk?
    YesNo
    Covid-19 positive diagnosis?
    YesNo



    19-21 Islington High Street

    Angel-Islington, London N1 9LQ

    020 7837 2300

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    Mon - Thurs 8am to 6pm Fri - 9am to 2pm

    Email Us

    info@londoncitysmiles.com