The Pentlands Medical Centre > Forms > Electronic Reviews > Hormone Replacement Therapy Review Form

Hormone Replacement Therapy Review Form

Please only complete this form if your GP has requested you to do so.

We can offer a telephone appointment  rather than having patients attend the surgery unnecessarily.  Below there are links to information

You will need an up to date blood pressure reading before you complete the online details. This can be easily organised using a home monitoring machine or through local pharmacies and Gyms. Please record this before you complete the application.

General information

Alternatives to HRT

HRT
Enter Email
Please use format day/month/year e.g. 12/05/1979

Your Height and Weight

Weight

Unit of measurement *
cm
kg
ft
in
lbs

BMI

Underweight
Healthy
Overweight
Obese

HRT Review

Are you happy with your current HRT? *
e.g. 120/70
Do you smoke? *
Have you ever had a blood clot, heart disease, stroke, cancer, migraine or major illness? *
Are you still in need of contraception? *
Are you suffering any menopausal symptoms? *
Have you had a hysterectomy? *
Do you have a coil in? *
Do you understand and have you read about all the risk and benefits of taking HRT? *
One of our clinicians will contact you on this number in the next couple of weeks.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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