Prescriptions: Pill check + Asthma + Medication Review

Please note the form below will help you complete both a contraceptive, medication & asthma review. 

You will need an up to date weight and blood pressure. Blood pressures can be done at home or in your local pharmacy.  

Information on various contraceptive can be found below: 

Regarding your asthma review, If your symptoms are significantly deteriorating or you are having any concerns please make a telephone appointment with our Nurse.

You may have received a text or a letter. This is because asthma reviews are an essential way of monitoring your symptoms and ensuring your medication is safe and appropriate. 

Please do not write any clinical queries on this form. Any clinical queries or request for appointments via this form will be discarded. To make an appointment either book online via the NHS app/Patient access or by calling reception. We will start to process your form by the next working day but it will take up to 5 working days to complete. Please DO NOT call before 5 working days as you will not receive a status update from reception or the administrative team. If you are NOT a registered patient then your form will be discarded. This service is only for patients registered at the surgery aged 16 and over; and for parents or legal guardians of children. Forms must be completed in the UK due to GDPR regulations.
Prescriptions: Pill check + Asthma + Medication Review
Contraception 'pill check' Review

Some medical conditions can mean hormonal contraception is not a safe option. Please answer the following questions below about your own health and family history.

This could be inbetween your periods if you have a regular cycle, or after sex
Medication Review
This relates to all your medications if you are on more then just the oral contraceptive. Please state the medication and the side effect. E.g. Paracetamol: Constipation
Please note that if your mental health is currently significantly impact and you are concerned for your well-being you must contact the crisis team on 0300 200 0011 and select option 1 or 999.
e.g. 120/80 (Upper valve/Lower value). If you are unable to provide your blood pressure reading then you will need to attend an appointment at the surgery for a blood pressure check before your prescription can be issued.
In Kg or Stones & lbs
Asthma Review
An exacerbation is where your symptoms got worse, your reliever did not help and you needed to seek medical attention.
Please note that your answer will not be seen immediately and you should direct any URGENT queries to reception.
Please note that your answer will not be seen immediately and you should direct any URGENT queries to reception.

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This information is retained for up to 28 days.

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Local Services, Let
Local Services, Let