Summary
Almost there - you just need to check your answers below.
Personal details
Name
Mrs Deborah Sanni
Date of birth
22/09/1992
Smoker status
Non-Smoker
Email address
career.debbie@gmail.com
Phone number(s):
07733818423
Occupation:
Engineering Technician
Address
35 Manor Road, Churwell, Morley, Leeds, West Yorkshire, LS27 7RU
life style
What is your height?
5' 2'
What is your weight?
22kg
In a regular week, do you consume more than 10 alcoholic drinks per week? (1 drink is equal to a pint, glass of wine or double measure of spirit)
No
Have you ever asked for or received advice to reduce your alcohol consumption?
No
In the last 10 years have you used: Recreational drugs? Any stimulants, sedatives, tranquilisers or anabolic steroids not prescribed by a doctor? Methadone?
No
Health
Have you ever had:
Angina, a heart attack, any form of heart disease or a brain haemorrhage or stroke (including mini stroke)?
No
Cancer (including leukaemia, sarcoma, melanoma, lymphoma) or any tumour of the brain or spine?
No
Multiple sclerosis, optic neuritis, cerebral palsy, paralysis, Parkinson s disease, Alzheimer s disease or dementia?
No
Diabetes or raised blood sugar?
No
Raised blood pressure or raised cholesterol other than fully resolved pregnancy related high blood pressure?
No
Occupation and sport
Do you have any plans or intentions to travel to Ukraine, Russia or Belarus; or Israel, the West Bank or Gaza Strip; or any other countries where there are areas of internal conflict or insecurity, or Are you a member of the Armed Forces, the Armed Forces Reserves or Territorial Army?
No