Medication Review

We review any regular medication on a repeat prescription annually and wherever possible the doctor or clinical pharmacist 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 be aware that any replies from the surgery may appear in your junk or spam inbox.

Medication Review

Medication Review

Please check that the surgery has advised you to submit this form before doing so.

Section

Is this your up to date telephone number? *

BMI

Please note: BMI calculator is only for patients aged 18 and over.

Blood Pressure

Some medicines require blood pressure to be monitored annually. During lockdown, however, we work hard to try to reduce the need for patients to attend the surgery in person. As such we have removed the mandatory need to enter your blood pressure.

If you don’t have a BP machine at home, a reading can be done at Lloyds Pharmacy, Sainsbury's, Forest Retail Park, London Road, IP24 3QL. For more information, please visit www.nhs.uk/services/Pharmacies.

To find another local Lloyds Pharmacy, please visit www.lloydspharmacy.com/store-locator.

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Do you currently smoke? *
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Do you understand why you have been prescribed your medication and what it is for? *
Do you know when and how to take your medication? *

Please speak to a Pharmacist or a GP to discuss the above.

Do you remember to take your medication every day? *
Do you have any concerns or side effects from the medication? *
Do you have any difficulties that affect how you take your medication? E.g. Problems swallowing, removing from containers, using inhalers or eye drops etc. *
Is there any medication on your repeat list that you are no longer taking and can be removed? *
Do you take medications for your mental health? *

Mental Health Medication

Are you happy with your current dose or treatment? *
Have there been any significant changes in your life since your mental health was last discussed? *
Do you have support from family, friends or other services? *
Do you take recreational drugs?
Do you drink alcohol?

Alcohol Consumption

This is one unit of alcohol:

Amount of different types of drink representing one unit of alcohol

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

Amount of different types of drink representing more than one unit of alcoholAmount of different types of drink representing more than one unit of alcohol
How often do you have a drink containing alcohol? *
How many units of alcohol do you drink on a typical day when you are drinking? *
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year? *
Which of the following do you predominantly suffer with? *

PHQ 9

Over the last 2 weeks, how often have you been bothered by any of the following problems:

Little interest or pleasure in doing things: *
Feeling down, depressed, or hopeless: *
Trouble falling or staying asleep, or sleeping too much: *
Feeling tired or having little energy: *
Poor appetite or overeating: *
Feeling bad about yourself — or that you are a failure or have let yourself or your family down: *
Trouble concentrating on things, such as reading the newspaper or watching television: *
Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual: *
Thoughts that you would be better off dead or of hurting yourself in some way: *

GAD 7

Over the last 2 weeks, how often have you been bothered by any of the following problems:

Feeling nervous, anxious or on edge? *
Not being able to stop or control worrying? *
Worrying too much about different things? *
Trouble relaxing? *
Being so restless that it is hard to sit still? *
Becoming easily annoyed or irritable? *
Feeling afraid as if something awful might happen? *

Are you happy for the doctor or clinical pharmacist to update your review date now? *
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