Combined pill review
We are using this secure online consultation to help review your pill. Once we have assessed your answers you may be able to complete your review without an appointment. You can also access some relevant health information.

OPTIONAL: You can submit a recent blood pressure reading, weight and height. You can check your blood pressure on your own machine. Alternatively, you can have this measured at your local community pharmacy or in the practice, but please first check if this service is currently running.

SAFETY: A blood pressure reading above 180/110 cannot be entered and should be reported urgently by calling the practice. Your answers will be attached to your medical record but may not be seen immediately. This system should never be used if you are in need of urgent medical attention. In this event, please contact the appropriate services (999 or 111) or the practice as normal.
If text is too small on your device, turn it sideways. You can also type the link you received into a tablet or computer browser to view on a larger screen
Practice Name - OFFICE USE ONLY *
This review is only for patients registered at the practice below. Please do not change under any circumstances
Data Processing Notice
Participation
To participate in this online review you must confirm the following by ticking each box. If you are unable to do so please contact the practice
First name *
Surname *
Month of birth *
Day of birth *
Year of birth *
How would you like to enter your weight? *
It is helpful to enter your weight if you know it, but you can complete this review if you would rather not
Next
Never submit passwords through Google Forms.
This form was created inside of MedLink Solutions Ltd. Report Abuse