Thank you for attending the lifestyle clinic. We hope you found it useful and that you will continue to attend the WALK TALK WALK or RUN TALK RUN sessions at 6.20pm every Tuesday from Clarendon Lodge Medical Practice Car Park.
Please if you could complete this form it will help us improve and develop the service.
Thank you
I would like to ask you four questions about your feelings on aspects of your life. There are no right or wrong answers. For each of these questions I’d like you to give an answer on a scale of 0 to 10, where 0 is “not at all” and 10 is “completely”.
Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to Clarendon Lodge Medical Practice • Clarendon Lodge, 16 Clarendon Street, Leamington Spa, Warwickshire, CV32 5SS.
Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.
Loading...