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Sixpenny Handley & Chalke Valley Practice NHS GP Surgery in Dorset and Wiltshire

Medication review

Medication Review

Section

Named GP (if known):

Do you understand why you are taking your medicine(s)? *

Yes

Do you take all of your medication regularly, as prescribed? *

Yes

Do you get any side effects from your medication? *

Yes

Please specify: *

Can you manage your medication yourself? *

Yes

Are there any medicines on your repeat list that can be removed? *

Yes

Please specify which medicines can be removed:

Do you know when and how to take your medication? *

Yes

Please speak to a Pharmacist or a GP to discuss when and how you should take your medication.

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

Yes

You may be required to visit the practice for a blood test and /or examination before we can fully complete your medication review.

I understand that I may need to visit the practice before my medication review is fully completed

I confirm that the information provided is accurate to the best of my knowledge

If you are human, leave this field blank.

The Sixpenny Handley Surgery
Dean Lane
Sixpenny Handley
Dorset
SP5 5PA

Get directions

01725 552500

The Broad Chalke Practice
Doves Meadow
Wiltshire
SP5 5EL

Get directions

01722 780282

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