Please answer below questions prior to your consultation and give details as appropirate.

Symptoms:

- Excessive thirst (polydipsia)?

- Urine output of > 3 litres/day (polyuria)?

- Blurred vision?

- Unexplained weight loss?

- Recurrent infections?

- Tiredness/Fatigue?

Past medical history:

- Established atherosclerotic cardiovascular disease (CVD) (e.g. coronary heart disease (including angina and myocardial infarction), stroke, transient ischaemic attack (TIA) or perhipheral disease (PAD))?

- Chronic kidney disease (CKD)?

- Chronic heart failure (CHF)?

Family history:

- 1st degree relative with CVD (diagnosis and age at diagnosis)?

- 1sts or 2nd degree relative with diabetes (type and age at diagnosis)?

Alcohol:

Alcohol units per week?

Smoking:

- Never smoked?

- Stopped smoking (date)? - Number of cigarettes per day?

Depression screening:

During the last month, have you often been bothered by feeling down, depressed, or hopeless?

During the last month, have you often been bothered by having little interest or pleasure in doing things?

If you answered 'yes' to one of the above 2 questions, please also answer if following symptoms have been present most days, most of the time, for at least 2 weeks:

- Disturbed sleep (decreased or increased compared to usual)?

- Decreased or increased appetite and/or weight?

- Fatigue or loss of energy?

- Agitation or slowing down of movements and thoughts?

- Poor concentration or indecisiveness?

- Feelings of worthlessness or excessive or inappropriate guilt?

- Recurrent thoughts of death, recurrent suicidal ideas, or a suicide attempt or specific plan?

Anxiety screening:

Have you experienced excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)?