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NHS Details

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Medical History & Lifestyle

Past Medical History*
(please list any serious injuries and operations)

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Current Health*
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If yes, how many units per week?*

Date of last cervical smear (F)

Date of last health check

Other Details

Family History (Diabetes / Heart Disease / Epilepsy / Hypertension / Psychiatric Disorder / Aortic Aneurysm / Nervous Disease / High Cholesterol / Depression / Cancer )

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