Medication Review

We review any regular medication on a repeat prescription annually and wherever possible the doctor will do this without you having to attend the surgery.

If you have been advised by the surgery that your medication review is due please use this form.

This will be reviewed by the doctor or pharmacist within 14 working days.

Medication Review

Medication Review

Review

Do you have any concerns or side effects from your medication? *
Do you know when and how to take your medication? *

Please speak to a Pharmacist or a GP to discuss when and how you should take your medication.

Are there any medications on your repeat prescriptions list that are no longer needed?
Do you have your prescriptions on repeat dispensing (a batch of prescriptions lasting up to a year in total)?
Would you like to try repeat dispensing (suitable if your medication is stable and unlikely to change)?
Smoking Satus:
Are you happy for the doctor or pharmacist to update your review date? *

Please enter your blood pressure readings if available

Day 1

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 2

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 3

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Average Blood Pressure

This is automatically calculated for internal use only.

Morning Measurement

/
Evening Measurement
/
*