Croydon NHS Health Checks Practice ProForma

Croydon NHS Health Checks
Practice Pro Forma

In Partnership with Croydon Council

Eclipse, in collaboration with Croydon Public Health and Croydon Borough Council, has undertaken work for the delivery of NHS Health Checks in your area. The NHS Health Check program is a preventive cardiovascular screening initiative targeting individuals aged 40-74.

Please complete the pro forma below to provide practice consent for this service.

Practice Name

National Practice Code

Programme Activation

NHS Health Checks Programme

Contacting Patients

1. Are you happy for patients within the activated cohort to be contacted by the Eclipse automated patient engagement interface? (NB: this will involve SMS messaging):

Yes

No

2. Are you happy for patients within the activated cohorts to be contacted by a patient engagement team? (NB: this will involve telephone calls):

Yes

No

3. Are you happy for patients to receive a feedback questionnaire for evaluation of the programme and to allow them to express any personal preferences:

Yes

No

Key Contacts

Practice Admin Lead:

First Name

Last Name

Email

Practice Clinical Lead:

First Name

Last Name

Email

Croydon NHS Health ChecksPractice Pro Forma

Eclipse Partnership Programme

Croydon NHS Health Checks
Practice Pro Forma