HRT Review Form

Please specify the name of coil and when you had it fitted(Required)

To continue safely prescribing HRT, we need to ensure that you remain aware of the potential risks with HRT. Please click the links below to information from NHS Inform and the British Menopause Society on the risks and benefits of HRT.

Hormone replacement therapy (HRT) | NHS inform

WHC factsheets and other helpful resources - Women's Health Concern

Name(s) and dose(s) of HRT currently taking(Required)

How long have you been taking your current HRT for?(Required)

Please provide details below(Required)

Please provide more information about the problems you are having(Required)

Please provide the details of the injection you are taking - name, dose and date commenced - as this could affect your contraception.(Required)

Weight (kg)(Required)

Height (cm)(Required)

Blood pressure (mmHg) from a home monitor or via a local pharmacy that offers BP check(Required)

Please advise how many cigarettes per day you smoke(Required)

How many units per week on average do you drink? 1 unit = half a pint of beer, a small glass of wine or one 25ml measure of spirit.(Required)

WHAT HAPPENS NEXT?

Once returned to the practice, a clinician will review your answers and issue your prescription as appropriate.

If there are any queries or we have reason to speak with you before your prescription can be issued, you will be contacted to arrange an appointment.

If there are no queries and we do not need to speak with you, your prescription will be issued for a year's supply* and sent to your preferred pharmacy. Please allow 7 working days before collection.

We will ask you to complete this review yearly, prior to your prescription being reauthorised, to ensure that it remains appropriate for you to continue taking.

URL

This field is for validation purposes and should be left unchanged.

Cookies on this website

Haddo Medical Group

HRT Review Form

WHAT HAPPENS NEXT?

Opening Times

A-Z of Symptoms

Body Parts

Self Help Guides