Riverside HRT Review Form

Please complete this form and check with the surgery on the progress of your prescription. This form is applicable for initiation and continuation of Hormone Replacement Therapy (HRT)

Last Updated: 25/03/2022

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HRT Review

HRT Questionnaire - Part 1

Please only complete this section if you have NOT been on HRT medication previously.

HRT Questionnaire - Part 2

If you are already prescribed HRT, please complete this section.

HRT Questionnaire - Part 3

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. *

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Riverside HRT Review Form

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