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

If you are human, leave this field blank.

Section

Named GP (if known):

Do you understand why you are taking your medicine(s)? *

Yes

No

Do you take all of your medication regularly, as prescribed? *

Yes

No

Do you get any side effects from your medication? *

Yes

No

Please specify: *

Can you manage your medication yourself? *

Yes

No

Are there any medicines on your repeat list that can be removed? *

Yes

No

Please specify which medicines can be removed:

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

Yes

No

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

No

You may be required to visit the practice for a blood test and /or examination before we can fully complete your medication review.

*

I understand that I may need to visit the practice before my medication review is fully completed

*

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

Submit