Health Assessment Refuser Form

You chose not to have your health assessment this year. Your feedback will help us understand how to make it work better for you and others.

Why did you decide not to have a health assessment? Required

I feel healthy and don’t need one

It makes me feel uncomfortable

I don’t find the assessment useful

Other reason

Is there anything we could do to make it easier or more comfortable for you to have a health assessment in the future?

Its ok for you to change your mind and if you would like to speak with one of our nurses, you can reach us at:

Telephone: 0191 5699129 (9am -5pm Monday to Friday excluding bank holidays)

Email: stsft.lachealth@nhs.net

I agree to the privacy policy