Diabetes Review Form

As part of our commitment to the care of your diabetes we would ask you to complete this questionnaire along with the annual medication review form prior to booking your appointment for a face to face review.

Last Updated: 06/04/2021

Patient Details





Care of your diabetes

Please answer the following questions to see how your condition impacts on your daily life and how well controlled your condition is.










Foot care








Erectile Disfunction (Men only)



Flu Jab and your annual review

People with diabetes are at high risk of complications with flu (influenza) and are therefore entitled to the annual flu vaccination. They are available from the end of Oct each year.