HRT medication 3 month review HRT Medication 3m Review Complete this form to review your new HRT medication or to request a change. After submission of this form: A clinician will review the form and action as appropriate and let you know by text message. We may need to phone you if we need any additional information. Patient Info Name * Date of Birth * Mobile number to contact you * How would you like to proceed with your medication? * My menopause symptoms are improved with the HRT and I would like to CONTINUE My menopause symptoms are not significantly better and I would like to INCREASE the dose I would like to REDUCE my dose of HRT I would like to STOP my HRT Something else (please outline below) Any further comments… 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. Consent * I agree to the privacy policy © 2022 Kristian Turnbull Submit
