HRT Review Form - Oak Tree Surgery

For repeat users, please complete this form and a member of the nursing team will contact you in due course.

We will not be able to process this form and make an appointment without an up to date blood pressure reading.

If you are not able to take a weight/height or BP measurement at home or at the pharmacy you can drop into the surgery between 8.30 and 6pm Monday – Friday and use the pod (ask at the front desk)

We will be in touch within 5 working days from the time you submit your form.

your name

Address

Postcode

Phone Number

Date of Birth

Blood Pressure

Height

Weight

All the above information needs to be complete before we can process this form. If you do not have a home BP machine the surgery POD BP machine is open between 8.30am and 6pm daily, no appointment needed

Please tell us the name of the HRT you are taking?

Do you feel the HRT is helping your symptoms? If no please give us more details

Are you having regular periods? Has your bleeding pattern changed since starting the HRT? Is so what change?

Are you taking any contraception? Do you feel you need contraception?

Have you had any changes to your health since the HRT has been started, eg new serious medical conditions, new breast lump etc

*All the above information needs to be complete before we can process this form. If you do not have a home BP machine the surgery POD BP machine is open between 8.30am and 6pm daily, no appointment needed*

All the above information needs to be complete before we can process this form. If you do not have a home BP machine the surgery POD BP machine is open between 8.30am and 6pm daily, no appointment needed