top
  
/ News & Downloads / Downloads
breakspear medical group

Pdf download information
  Articles
Breakspear Hospital Trust
Flu, travel and other vaccinations (including MMR)
General information
Guesthouse information
New patient forms
Order forms
Treatment programmes

Breakspear Hospital has many forms, information booklets, surveys, publications and other pdfs for people to download from our site.  To save you navigating around the site to find the right page with the right form, we've put them altogether on this page.

If you have Adobe Reader, simply click on the desired forms and print out the full colour pdf.

 

Articles

 

Allergy Management

An article by Breakspear's Dr Jean Monro which appeared in The NHS Guide to Healthy Living or download the whole guide from www.nhsta.org.uk.

 

Gain control of your health

An article which appeared in Allergy Magazine featuring an allergy promotion on Breakpear Hospital's allergy treatments and services.

 

The war of ME and me

An article written by the daughter of Michael Ancram, Lady Clare Kerr which appeared in the Times in 2003 and describes her treatment at Breakspear Hospital.

 

The link between CFS and stealth organisms

An article written by Breakspear's Dr Jean Monro for What Medicine magazine in 2004.

 

Diagnositics and nutrition for people with HPV

An article in Positive Health Magazine featuring Breakspear's at-home HPV testing kit.

 

Breakspear Hospital Trust

 

Information leaflet

This leaflet provides information about Breakspear Hospital Trust such as who founded the Trust and what they hope to achieve.

 

Donation form

If you would like to support Breakspear Hospital Trust, please complete this form and return by post.

 

Flu, travel and other vaccinations (including MMR) 

 

Child vaccination/immunisation form

This form is the essential for MMR patients who are children.  It is to be completed before any of the vaccinations are administered.

 

Adult vaccination/immunisation form

This form is the essential for MMR patients who are over the age of 16.  It is to be completed before any of the vaccinations are administered.

 

Child medical questionnaire and consent form for BCG & skin test

This form is essential for children who are going to receive a vaccination or be tested for Tuberculosis.

 

Adult medical questionnaire and consent form for BCG & skin test

This form is essential for patients over 16 who are going to receive a vaccination or be tested for Tuberculosis.

 

Special Report: Individual MMR Vaccinations

An information booklet on why Breakspear offers separate vaccinations for measles, rubella and mumps and loads of information for parents who are trying to make the decision.

 

Child vaccinations and milk or egg sensitivity

An information booklet to help parents of children with a suspected milk or egg sensitivity determine if they should be concerned about administering various childhood vaccines.

 

General information

 

Patient satisfaction questionnaire

A leaflet with a series of questions for the first time or regular patient of Breakspear Hospital which will help us provide you with better services.

 

Guesthouse information

 

Guesthouse information leaflet

An information leaflet about the Guesthouse available for patients attending Breakspear Hospital including the address, booking details and facilities available.

 

Guesthouse satisfaction survery

A leaflet with a series of questions for the first time or regular guests of the Guesthouse which will help us provide you with better service.

 

New patient forms

There are 4 primary forms which must be completed before new adult patients meet their doctor.

The forms for adult patients are:

 

Patient Record Card

This form provides the Hospital with the patient's name, address, next of kin and other required information.

 

Medical Questionnaire

This form is for the patient to complete and will give the doctor a clearer idea of the patient's specific symptoms and medical history.

 

Symptom Scoring Chart

This form is to grade the current symptoms.  During on-going treatment, patients will be asked to complete this chart again, to monitor improvements.

 

Fee Consent form

This form is the payment contract between the patient and the Hospital.

There are 4 forms for patients under 16 years of age which are:

 

First Time Visit Child Consent Form

This form is to verify whether parents/guardians would like any test results or other information forwarded to the child's GP.

 

Patient Record Card

This form provides the Hospital with the child's name, address, next of kin and other required information.

 

Medical Questionnaire

This form is to be completed by the parents and patient to give the doctor a clearer idea of the patient's specific symptoms and medical history.

 

Fee Consent form

This form is the payment contract between the parent/guardian and the Hospital.

 

 

Order forms

 

Pathology Patient Order Form

This order form is so that patients of Breakspear physicians or Breakspear registered practitioners can order various pathology tests directly.  Print out and fax the order to +44 (0) 1442 266 388.

 

Pathology Practitioner Order Form

This order form is so that Breakspear registered practitioners can order various pathology tests directly.  Print out and fax the order to +44 (0) 1442 266 388.

 

Pharmacy order form

This order form is so you can re-order all supplements prescribed for you during your stay and maintenance treatment after discharge. Fax the order to +44 (0) 1442 266 388 or mail to the Hospital, attention "Pharmacy" or drop the form off at the Hospital.

 

Antigen vaccine order form

This order form is so you can re-order your tailor-made antigen vaccines. For instructions how to use this form, visit Instructions for re-ordering antigen vaccines.

 

 

Treatment programmes

 

CFS/ME Treatment Programme

An information booklet about the causes of CFS/ME, Breakspear Hospital's treatment approach and the commonly recommended tests, supplements and treatments for CFS/ME.

 

Chelation Therapy

An information booklet on Breakspear's chelation therapy and provides general information about which conditions chelation might help and about sources and absorption of heavy metals.

 

Child vaccinations and milk or egg sensitivity

An information booklet to help parents of children with a suspected milk or egg sensitivity determine if they should be concerned about administering various childhood vaccines.

 

Rehabilitation Programme (greyscale)

An information booklet about Breakspear's approach to alcohol and other addictions and our treatment programme.

 

Whole-body hyperthermia treatment (greyscale)

An information booklet on our hyperthermia infrared-A bed called the IRATHERM®1000, often recommend for detoxification programmes.

 

Weight-loss Programme

An information booklet on Breakspear's approach to weight loss, which includes help to fight the cravings and access to metabolism boosting equipment.

 

Time for a cervical health screen?

An information leaflet about why it is important to have regular screenings and telling about the at-hospital and at-home kit available for detecting HPV.

 

 

 

 

 

HOME | ABOUT US | TREATMENTS | PRODUCTS & SERVICES | THE HOSPITAL | OUR TEAM |NEWS | FAQS | CONTACT US
©2004 Breakspear Medical Group Ltd. View Website Disclaimer, Copyright and Privacy Statement    | site map |
Page updated: February 19, 2008 Website designed and maintained by AMGmedia Works Inc.