Hypothyroid Self Assessment Please be aware that any replies from the surgery may appear in your Junk Inbox. Name First Last Date of Birth Day Month Year PhoneEmail Enter Email Confirm Email Weight Pulse If it is less than 60 or above 80 when resting please discuss this with your doctorChange in Weight: Abnormal weight gain Abnormal weight loss About stable weight Have you had your blood tested for thyroid in the last 9 months? Yes No I can’t remember