NHS Health Check Eligibility

Name:

Address:

Contact number:

Date of birth:

Q1) Are you aged between 40 – 74 Inclusive?
If YES, please proceed to question Q2. If NO, unfortunately you are not eligible.

 
 

Q2) Have you had an NHS Health Check in the past 5 years?
If NO, please proceed to Q3. If YES, unfortunately you will not be eligible this time.

 
 

Q3) Have you been diagnosed with the following?
If the answer to any of these health questions is YES, you will not be eligible for an NHS Health Check.

 
 
 
 
 
 
 
 
 


Thank you for completing this survey. If you are eligible for an NHS Health Check, a member of our reception team will contact you shortly.