HRT Review Form

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Please only complete this HRT review form if you have been requested to by one of our clinicians.

Please remember, as with most medicines, it is best to be on the lowest effective dose. Please arrange to speak to a GP routinely if you would like to discuss reducing your treatment.

Once you have completed this form your answers will be reviewed by a clinician and a prescription will be issued or a request for further contact will be made.


*If YES, please contact the surgery to book a review with your GP as soon as possible.


Blood Pressure Reading
If you have access to a Blood pressure machine, please add your reading here.
If not, please come to the practice and request use of the waiting room BP machine and give the reception team your result. This will then be checked to ensure it is safe to prescribe for you.

If you are due a smear test we would recommend you book this via our reception team.
Click here for more information on cervical screening

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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