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 practice.

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

Medication Review

Please use this date format: DD/MM/YYYY.
Do you take your medication every day as prescribed?

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

Do you understand why you are taking all your medication?
Do you have any difficulties in taking your medication (for example with opening blister packs or bottles)?
Do you think you are experiencing any side effects or issues with your medications?
Do you have any questions or concerns about your medications?

If you are due an annual blood test we may contact you to arrange this.

Smoking Review

Do not currently smoke section

Do currently smoke section

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

Alcohol Consumption

This is one unit of alcohol:

And each one of these, is more than one unit:

This is your total score from the first part of the Alcohol Consumption form.

Alcohol Consumption - Part 2

A total of 5+ indicated increasing or higher risk of drinking. As you have scored 5 or more, please now fill in the questions below.
This is your total score the Alcohol Consumption form.