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.

On or around the review date printed on your repeat prescription please complete this form. Or if you have been advised by the surgery that your medication review is due please use this form.

Medication Review

Please use this date format: DD/MM/YYYY.

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

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.

Blood Pressure

Please provide a blood pressure reading.

This can be complete at home if you have a blood pressure monitor or you can come into the medical centres hub any time and use the blood pressure monitor.

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Height and Weight

Please provide your height and weight for our records.