Heart failure questionnaire

Use this service to submit heart failure questionnaire.

If your symptoms are deteriorating or you are having any concerns, please make an appointment with our nurse.

For more information, please visit www.bhf.org.uk.

You can use this service if you:

• are registered at the surgery
• have been invited to do so

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of

Start now

You can also phone us on 01543 416633.