Diabetes

Please make your CDM Clinic appointment for your blood test before filling out this form.

You can view your past hba1c results on this website

Contact us if you have any issue logging into this.

Diabetes
Please use format day/month/year e.g. 12/05/1979
New (Past 6 weeks): Increased urination?
New (past 6 weeks): Increased thirst?
Have you seen a podiatrist in the past 2 years?

If you have any foot concerns, please self-refer to podiatry on 01698 753753.

Have you had your diabetic eye screening in the past 2 years?
If No please call 0300 303 0244 to arrange this appointment.
Are you experiencing any issues with erectile dysfunction?
Male Patients only
If yes and you wish to discuss this further please submit a triage before 10am detailing your issue.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.