The Golden Brook Practice, Long Eaton Health Centre, Midland Street, Long Eaton, Nottingham, NG10 1RY Tel: 0115 8554200

Golden Brook Practice Forms

The following forms are useful in accessing the help you need from the surgery.

Please print off the forms as needed and hand in to reception.

It is important that you fill in all of the relevant information (especially name, date of brith and address – as requests cannot be processed without these three details)

Update Your Details

Update Your Details form

Repeat Prescription Request

Repeat Prescription Request Form

Sick Note Request

Sick Note Request Form

The Golden Brook Practice Registration Documents

Registration Documents

Self Assessment Forms

Sometimes your doctor will ask you to complete a self assessment for relating to your condition. Please print off the PDF files below and complete them in advance of your appointment. If you are unable to print, please contact the reception team who will be happy to provide you with a hard copy.

Epworth Sleepiness Scale

ESS PDF 1990-97.pdf

International Prostate Symptom Score

ipss.pdf

Oxford Knee Score

Oxford Knee Score.pdf

Oxford Hip Score

Oxford hip score.pdf

PHQ-9, Depression Score

PHQ-9_English.pdf