Ibstock & Barlestone Surgeries

132 High Street, Ibstock, Leicester, LE67 6JP

Telephone: 01530 263467


Sorry, we're currently closed. Please call NHS 111

Barlestone Surgery, Westfields, Barlestone, CV13 0EN | Telephone: 01455 299920 | ibstockhouse@nhs.net

Patient Downloads

Patient Downloads

please note, all forms once completed can be emailed to: ibstockhouse@nhs.net. Please remember to include your name, date of birth and address in your email. Thank you.

Information relating to NHS Health Check

NHS Health Check – NHS (www.nhs.uk)

Home Blood Pressure readings

Our 7 day blood pressure recording form can be found here.

Consent for a Third Party to Act on your Behalf for Medical Matters

If you would like a third party such as a family member or carer to be able to discuss any medical matters relating to you, please download the form here.

Midwife Form (Essential Information For The Midwife)

Essential Information for Midwife

Sleep Questionnaires

If the GP has asked you to complete sleep questionnaires, they can be downloaded here.

Letter to Schools regarding Over the Counter Medicines for Children

Please download the letter here.

Managing your personal data

Summary Care Record Opt in or Out form can be downloaded here.

Children ADHD & Autism Questionnaire

Community Paediatrics Pre-School ADHD & Autism report – download here.

Community Paediatrics up to Year 6 ADHD & Autism report – download here.

CAMHS secondary school report – download here.

CAMHS parent report – download here.

Adult ADHD & Autism Questionnaire

Adult ADHD report – download here.

Adult Autism ASRS and Past & Present behaviours reports – download here.

Please be advised, if you are completing the forms for an Autism referral. Please ensure both Adult forms are filled out.

Right to choose ADHD & Autism

Due to the long NHS waiting list for ADHD & Autism assessments, please note that a direct NHS referral isn’t the only option. Please see further information linked below.

Right to choose information for children

Right to choose information for adults