Skip to main content
Skip to footer
University Hospitals of North Midlands
Menu
Home
Patients and Visitors
Getting here
Working here
Expand sub pages Working here
Join UHNM
About Us
Expand sub pages About Us
Our Hospitals
Our Board
Our Organisation
Regulatory information
Consultant Directory
UHNM and The Armed Forces
For professionals
UHNM Charity
Accessibility
Contact Us
Expand Search
Home
Our Services
Lung Health Checks
Request an Appointment for a Lung Health Check
Request an appointment
Consent for storing submitted data
Yes, I give permission to store and process my data
Name
Date of Birth
Address
NHS number
This can be found on your prescription or NHS app
Telephone Number
Mobile Number
GP Name
GP address
Do you currently smoking or are you a former smoker?
Yes
No
Preferred appointment time
Which option would suit you best for attending your appointment (please note this is a telephone appointment and your appointment may be sent to you via the post)
Weekday
Evening
Saturday
Dates unavailable
Please let us know if there are any dates you are unable to attend
How did you hear about us?
Social media
Invitation letter
GP practice
Advert in magazine
Petrol pump
Staffordshire Fire Service
Other
