Request for a 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 to request one.

Medication Review

If you are human, leave this field blank.

Please be aware that this is only a request, your full review will be arranged following submission of this form.

Named GP (if known):

Please provide a recent blood pressure reading. If you do not have access to a blood pressure machine, please come to the surgery and use the one in the reception area.

Systolic "Higher"

Diastolic "Lower"

Heart Rate

Do you have any concerns or side effects from your medication? *

Yes

Please specify:

Do you know when and how to take your medication? *

Yes

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

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

Yes

Please add any comments regarding your medication that you feel are appropriate:

I confirm that the information provided is accurate to the best of my knowledge

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Request for a Medication Review

Medication Review

Hay Fever