Drug Medication Reviews

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Personal Details
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Questionnaire
Do you understand the purpose of each of your medications?: *
Are you able to take your medication as directed on the labels? : *
Are your medicines effective in controlling your symptoms?: *
Have you experienced any side effects which may be attributable to your medication?: *
Do you have any problems, which if addressed, would assist you taking your medication?: *
Have you stopped taking any medications and can these be removed from your repeat list?: *
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Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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