HRT Screening Form

Please use this form if you have made a hormone replacement therapy (HRT) prescription request. You will need a medication screening review – if you do not have this, then please call our receptionist. The receptionist will make a screening appointment with a clinician and you may get a call from our receptionist if there is a need for a further discussion.

 

Please do not use this form if you want to discuss or are considering starting HRT; instead, call the practice to make a GP appointment.

Last Updated: 01/11/2024

PERSONAL AND PRESCRIPTION DETAILS







CLINICAL RISKS AND BENEFITS OF HRT

The benefits of HRT usually outweigh the risks with recent evidence showing that the risks of serious side effects from HRT are very low.

 

The risks and benefits are documented on the NHS website - please click here for more information, which was updated in February 2023 with a review due in February 2026. Further information about the risks and benefits are documented on the NHS Inform - please click here for more information.

 

Please be reminded that HRT is not a replacement for contraception.

 

 

We would be grateful if you could read this information to make an informed decision on continuing HRT.




CLINICAL INFORMATION

If you have read, understand, and are happy to continue with your HRT and you do not wish to discuss further, the clinician will look at the answers you provide to the clinical information below. The clinician may contact you to clarify information, but if the clinician is happy with your answers they will issue and send the prescription for you on the date that the receptionist organised the clinician screening review for you to the chemist that you have indicated above.

 

If you have asked for a further clinician discussion for HRT, or the clinician wants a further discussion, the receptionist will call you for an appointment. 

 

To help the clinician with the prescription, please could you answer a few of the following questions:

 

Please also click on the links below as suggested by the below questions













DATA PROTECTION AND CONSENT


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