Klinik – Patient feedback regarding sub-tiles

We’ve had some feedback that some patients after selecting the ‘new’ or ‘existing’ health problems tiles, have found they cannot continue and believe that there is an issue with Klinik. However this isn’t the case, instead one of the 5 sub-tiles, needs to be selected.

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The Adam Practice > Your Health > Health Review Forms > Breathlessness Review Form

Breathlessness Review Form

Breathlessness Review

First Name *

Last Name *

Email *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Your Breathlessness Review

How do you rate your level of breathlessness? *

I’m not troubled by breathlessness

I get breathless when I undertake vigorous exercise

I get short of breath when hurrying or walking up slopes

When walking I have to stop from time to time or walk slower due to breathlessness

I have to stop for breath after a few minutes of walking a short distance on level ground

I’m too breathless to leave the house and get breathless when getting dressed

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.

I consent to the practice collecting and storing my data from this form.

Klinik – Patient feedback regarding sub-tiles

Breathlessness Review Form

Your Breathlessness Review

Privacy Policy

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