Call us: 01524 843333

Email: [email protected]
Address: 2 Queen Square, Lancaster, LA1 1RP

New Patient Health Questionnaire (Adult)

Step 1 of 5

  • Your contact details

  • DD slash MM slash YYYY
  • Next of Kin

  • Information About You

    If an interpreter is necessary, please inform us each time you book an appointment
  • If you are unable to provide your blood pressure at this time, there a blood pressure monitors in the waiting areas of Queen Square Medical Practice and Caton Health Centre.
  • Repeat Medication

    If you answered yes, you need to make an appointment with either an Advanced Pharmacist Practitioner or a GP to obtain your next prescription.

Date published: 8th February, 2021
Date last updated: 2nd March, 2021