CLANGERS

Please complete if requested to do so by your Clinician. CLANGERS is a widely used support and self-help program Guildhall Surgery has adopted for patients who are prescribed opiates for non-cancer pain. The individual elements of CLANGERS are: (C)ONNECT, (L)EARN, (A)CTIVE, (N)OTICE, (G)IVE BACK, (E)AT WELL, (R)ELAX, (S)LEEP Within each of these elements of the program we assist our patients to better understand how their pain can be managed without increasing, and maybe even reducing, their intake of opiates which is desirable as it is understood that the effect of opiates in providing pain relief is time limited whilst long-term use of opiates is also damaging. If you are asked to complete this form as part of the CLANGERS process please provide us with as much information as possible to help us to help you.

Last Updated: 23/04/2021

Your Details

Full Name *

Date of birth *

About You

Tell us about your average day. Just describe it as best you can.

In your own words tell us about you and your life, your family and and friends, social life and support.Be as detailed as you can be and try to give us a picture of you the person.

Tell us about your pain. Where you have your pain, the causes of your pain, the effect your pain has on your day-to-day life and the lives of those close to you/

Tell us about the activities you do. What activities do you enjoy, how regularly active are you and what activities would you like to do but can't because of your pain/

Tell us about your lifestyle. Do you eat, drink and sleep well and if not what are the problems you think you have in these areas. How are your lifestyle choices affected by your pain.

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA. * *

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CLANGERS

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