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.

Medication Review

Medication Review

Section

Are there any concerns or side effects from the medication? *
Do you know when and how to take your medication? *
Are there any medications you are not using regularly that you would like to be removed from your repeat prescription? *
Smoking status: *
How many cigarettes did you smoke in a day?
How many cigarettes do you smoke in a day?
Would you like to give up smoking?

Please ask at reception for more information about giving up smoking.

Are you happy for the doctor to update your review date now? *
*