Contraception / HRT medication request Form

For new starters and repeat issues, 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.

This form is for patients who are not yet taking HRT but feel they have menopausal symptoms and would like to discuss these with a doctor.