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If you wish to record your symptoms so that you can give an accurate picture to the doctor when you come to your appointment then this form may be useful. This form should NOT be handed in to Reception or sent to the practice, it is purely for the patient to record any symptoms to remind themselves what they need to report to the clinician when they come for their appointment.
For any patients who require tests/medication/treatment etc from the NHS after consulting a private healthcare
practitioner, see the BMA Guidelines below.