Online Medication Review

Is this the right review form for you? Please note that there are separate forms for Asthma, COPD, the contraceptive Pill and medication reviews. Please ensure that you complete the correct form.

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.

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

If you would like help to quit smoking, please visit www.smokefreehampshire.com.

Alcohol Consumption

This is one unit of alcohol:

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

As you've scored more than 5 this may indicate increasing or higher risk of drinking. Please complete the second section of the questionnaire.

Alcohol Consumption - Part 2