HRT REPEAT REQUEST FORM

For repeat issues, please complete this form and a member of the team will contact you if required. If you would like to discuss new treatment, then please book in for an appointment with a doctor.

Last Updated: 27/05/2022

YOUR DETAILS





HRT QUESTIONNAIRE











HEALTH QUESTIONNAIRE

Completing this section will help us get your prescription to you quicker.






DISCLOSURE - 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 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. By completing this form, you consent to the practice collecting and storing the data on this form.

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