Epilepsy Review

If you have been advised by the surgery to submit a epilepsy review please use this form.

Please be aware that any replies from the surgery may appear in your junk or spam inbox.

Epilepsy Review

Epilepsy Review

Section

Is this your up to date telephone number? *

Epilepsy Review

How long has it been since your last epileptic fit?
Are you currently on treatment for epilepsy?
How often do you have an epileptic fit?
Are you a woman aged between 18 and 55?
Would you like some information regarding contraception, conception and pregnancy and how this is affected by your epilepsy medication?

Please make an appointment with a practice nurse to discuss this further.

Section

*