League of Friends Data Submission Point Use the form below to submit each case. Friends of Milford Full Name * Date of Birth * First line of address Home phone number Mobile phone number Email address What surgery are you registered at? * Wistaria & MilfordChawton House SurgeryLyndhurst SurgeryNew Forest Medical Group Smoking status Never Smoked Ex-Smoker Current Smoker How many do you smoke a day? Do you drink alcohol? Yes No How many units in an average week? Ethnicity Date of readings Average BP reading If you are human, leave this field blank. Submit
