University Student Questionnaire

By providing your email and mobile you consent to the practice contacting you by these methods of communication for direct patient care- including screening programmes. please bear this in mind if you share an email account.

Last Updated: 30/04/2021

Your Contact Details

Information About You

Transgender Patients

We may need to ask you for further information to be able to locate your medical records.

Medical Information

That requires current treatment and/or regular medication. If you take regular medication please email a copy of your most recent repeat prescription counterfoil or book a telephone appointment with our clinical pharmacist to set up these medications so you can continue taking them.


If you are over 18, and this is your first ever year at a university, you will be eligible for this vaccine. Many of you will have received this before leaving home to come to university but if not, we will be in contact with you. Overseas student? We will need you to supply us with a list of the vaccinations you have received.

Females Only


If you would like help and advice please phone Healthy Cornwall 01209 615600 to book an appointment with a stop smoking counsellor.



if you would like to allow the Practice to discuss medical matters with your parent(s), next of kin, guardian or nominated person please complete their details below: This consent will remain on your notes until you advise the surgery otherwise.

Summary Care Records

A Summary Care record is an electronic record that can help give you safer, faster care by giving healthcare staff instant access to information about your MEDICINES, ALLERGIES and MEDICINES which make you ill.

Enhanced Data Sharing

SystmOne is the clinical computer system used by Penryn Surgery. Opting into this method of sharing your medical information will allow other services who use this same clinical computer system, eg District Nurses, to access your medical record but ONLY if they have need to do so for your clinical care.

National Data opt-out

Information about your health and care helps the NHS to improve your individual care, speed up diagnosis, plan your local services and research new treatments. In May 2018 strict rules about how this data can and cannot be used were strengthened. You can choose whether your confidential patient information is used for research and planning. To find out more visit Leaflets on all the above data sharing models can be obtained from reception.