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

Medication Review

Do you take your medication every day as prescribed?
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.

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

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

Smoking Review

Do you currently smoke?

Do not currently smoke section

Have you smoked in the past?
How many cigarettes did you smoke in a day?

Do currently smoke section

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.

Alcohol Consumption

This is one unit of alcohol:

Amount of different types of drink representing one unit of alcohol

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

Amount of different types of drink representing more than one unit of alcohol
How often do you have a drink containing alcohol? *
How many units of alcohol do you drink on a typical day when you are drinking? *
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year? *
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.
How often during the last year have you found that you were not able to stop drinking once you had started? *
How often during the last year have you failed to do what was normally expected from you because of your drinking? *
How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session? *
How often during the last year have you had a feeling of guilt or remorse after drinking? *
How often during the last year have you been unable to remember what happened the night before because you had been drinking? *
Have you or somebody else been injured as a result of your drinking? *
Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down? *
This is your total score the Alcohol Consumption form.