We have created this form to improve patient convenience and access to contraceptive or HRT medication.

All under 18's need a Face to Face appointment and should to contact the medical centre.

Please complete this form IN FULL for review by the clinical team.

It is very important that we have an up-to-date Height, Weight and Blood Pressure reading to allow us to issue a prescription.

Failure to enter this will mean a script may not be issued as this information is required.

Alcohol Consumption