Privacy Notice
Please review the full NHS Health Check Programme Privacy Notice before proceeding. NHSHealthCheckProgramme.pdf
This form is used to determine whether you are eligible for a full NHS Health Check or a mini health check as part of our workplace health initiative.
Important:
If you are a Halton resident and undergo a full NHS Health Check, relevant information from your assessment will be securely forwarded to your registered GP. Your GP may follow up if necessary.
Purpose of the NHS Health Check
The NHS Health Check is a preventative programme aimed at identifying individuals who may be at increased risk of developing:- Heart disease- Stroke- Type 2 diabetes- Kidney disease’
Eligibility is based on criteria set out by the Department of Health and Social Care.
If you are not eligible for a full NHS Health Check, we are still happy to offer a blood pressure check and signpost you to relevant health services. If you have any ongoing concerns, please consult your GP.
Eligibility Questions
Please answer the following questions honestly:
| Question | Yes | No |
| 1. Are you aged between 40 and 74? | ☐ | ☐ |
| 2. Do you live in Halton? | ☐ | ☐ |
| 3. Do you work in Halton? | ☐ | ☐ |
| 4. Are you registered with a GP in Runcorn or Widnes? | ☐ | ☐ |
| 5. Have you had an NHS Health Check in the last 5 years | ☐ | ☐ |
| 6a. Have you been diagnosed with Heart Disease? | ☐ | ☐ |
| 6b. Have you been diagnosed with Chronic Kidney Disease (Stages 3–5)? | ☐ | ☐ |
| 6c. Have you been diagnosed with Diabetes? | ☐ | ☐ |
| 6d. Have you been diagnosed with High Blood Pressure (Hypertension)? | ☐ | ☐ |
| 6e. Have you been diagnosed with Atrial Fibrillation (AF)? | ☐ | ☐ |
| 7. Have you ever had a Stroke or TIA? | ☐ | ☐ |
| 8. Are you currently taking prescribed medication for cholesterol (Statins)? | ☐ | ☐ |
| 9. Are you currently taking prescribed medication for high blood pressure? | ☐ | ☐ |
Eligibility Criteria for a Full NHS Health Check
You are eligible for a full NHS Health Check if:
You answer YES to Question 1,
AND YES to any of Questions 2, 3, or 4,
AND NO to Questions 5 to 9
If you are not eligible for a full health check, we will offer you a mini health check (e.g., blood pressure and lifestyle advice).