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

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.

Smoking Review

Do not currently smoke section

Do currently smoke section

If you smoke we strongly advise that you stop. If you would like help with this please speak to reception about our in-house clinic

Alcohol Consumption

This is one unit of alcohol:

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

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 form will be reviewed by your GP and if happy they will complete and update your review. Alternatively, you may be required to make an appointment with your GP.