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New or specific medication review

New or Specific Medication Review

Section

If you are completing this form on behalf of someone else, please enter their details in the following sections.

This should have been indicated to you on your invite message of by a member of practice staff.
For example, one tablet daily or applying one patch weekly.
Do you ever forget to take your medication?
For example, how often this happens, which medicines, and any reasons why.
Are there any concerns or side effects from the medication?
Are these effects manageable?
Are you taking this medication for your mental health? *
Do you think your mental health is getting better, getting worse, or staying the same? *
Do you feel the medication Is working well for you?
Are you happy with the current dose of the medication?

For immediate help

This is not an emergency form. If you are experiencing thoughts of harming yourself or feel you may be in crisis, please do not use this form for urgent help.

Contact the surgery directly, or call 111 and select option 2 for urgent mental health support.

Next Steps

What would you like the practice to do now? *
How would you prefer us to contact you? *

If you need your medication issued now, please request it in the usual way.