Medication Review Form

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Personal Details

This form should not be used for Repeat Medication Requests.

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.

Please double check you've entered the correct email address
May be used to identify you
Do you collect medication from our Dispensary, or do we deliver your medication to you?

This form is for Dispensing patients only. Any forms filled in by patients who are NOT dispensing will be deleted.

As a non-dispensing patient, If you wish to have a medication review with your GP please fill in this form through our eConsult platform, between 9:00am and 4:00pm Monday - Friday, on a day your usual GP is working. Find out when your usual GP is working on this page.

Dispensing Review of Use of Medicines
(example – do you find containers difficult to open?)

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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