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.

Please note – if you submit this request after 4pm on a working day, it will be opened when we re-open on the next working day. The practice is closed over the weekend.

Medication Review

Medication Review

Do you have any concerns or side effects from your medication? *
Are you taking medication to control your blood pressure?

Blood Pressure

Please provide us with the last 3 blood pressure readings you have taken at home.

For a list of validated home blood pressure monitors, visit www.bihsoc.org/bp-monitors or discuss with your pharmacy.

Day 1
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Day 2
/

Day 3
/

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.

How are you feeling? (1 being sad, depressed or down / 5 being not happy or sad / 10 being happy, awesome, great)
Are you happy for the doctor to update your review date now? *
*