City of Melbourne Health Check

Congratulations on scheduling an appointment to participate in the City of Melbourne Health Check Program conducted by Midtown Medical Clinic!

We are proud to be conducting the COM Health Check Program for the fifth time. We have been providing comprehensive medical care for over 30 years and look forward to helping you learn more about your health. This brief health check is designed to provide you with a snapshot of your current physical and mental health status, to enable you to better manage your health.

Below are a series of questions that will tell us more about you and your health. When your completed survey is submitted, it will come to Midtown Medical Clinic via a secure and encrypted email. We are committed to maintaining the confidentiality of your personal health information. It is our policy to maintain security of personal health information at all times and to ensure that it is only available to authorised members of staff. We have a comprehensive privacy policy that you are more than welcome to read.

Our experienced Dietitian Emily Commerford will be conducting your health check here at Midtown Medical Clinic (Level 4, 250 Collins Street, Melbourne). She will have reviewed your submitted survey prior to your appointment. During your appointment she will conduct a series of tests including blood pressure, a blood test, a waist measurement and will provide appropriate health recommendations.

Taking part in this program is completely confidential and your results will only be used anonymously for statistical analysis and reports. These analytical reports will assist COM in delivering a relevant health and wellbeing program to you and your colleagues.

Please be aware, your health check is a health risk assessment only and is not designed to be diagnostic. If any concerns are raised during this screening or you are advised to follow up on a result, we recommend you arrange an appointment with your regular GP.

Please ensure you have scheduled your appointment prior to commencing the survey below. You can schedule your appointment here.

    PERSONAL DETAILS









    MEDICAL & FAMILY HISTORY
    DIABETES





    CARDIOVASCULAR DISEASE



























    CANCER











    OTHER SIGNIFICANT MEDICAL CONDITIONS







    MENTAL HEALTH
    Please read each statement below and circle a number 0, 1, 2 or 3 which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.
    The rating scale is as follows:
    0 - Did not apply to me at all
    1 - Applied to me to some degree, or some of the time
    2 - Applied to me to a considerable degree or a good part of time
    3 - Applied to me very much or most of the time










































    HEALTH & LIFESTYLE
    EXERCISE




    SLEEP



    NUTRITION





    ALCOHOL







    SMOKING



    GENERAL QUESTIONS







    Thank you for completing your health check survey. You can now submit your responses. We look forward to seeing you!