Welcome to Breakspear Medical
Thank you for choosing us for your healthcare needs. We’re pleased to welcome you to our clinic and look forward to supporting you on your healthcare journey.
Secure & confidential
Your privacy is our priority. This medical questionnaire is protected by our HIPPAtizer programme, ensuring all your personal and medical information is securely encrypted and HIPAA-compliant. You can complete this form with complete confidence that your data is safe.
Before you begin
Please complete this questionnaire at least 5 days before your scheduled appointment. This allows our Clinical Team adequate time to review your medical history and prepare for your visit, ensuring we can provide you with the best possible care from the moment you arrive.
The questionnaire should take less than 15 minutes to complete. Please answer all questions as thoroughly and accurately as possible. The more we understand about your health history and current concerns, the better we can tailor our approach to your individual needs.
If you have any questions while completing this form, or if you need to discuss your appointment, please don’t hesitate to contact us.
We look forward to meeting you soon.
