HRT Questionnaire

Thank you for completing this form. We are aiming to avoid the need for you to see a clinician in order to re-issue your HRT. WE ARE UNABLE TO ISSUE A PRESCRIPTION WITHOUT UP TO DATE BLOOD PRESSURE AND WEIGHT MEASUREMENTS. Blood Pressure machines available at reception if you don’t have one at home.

For information on HRT Myths click here

For information on HRT medication types & doses click here

You might want to monitor your symptoms and is worth doing regularly to assess how symptoms change with time or with treatment. Download the Menopause Symptoms Questionnaire here or download the balance app to take the balance Menopause Symptom Questionnaire

Please note it will take 4 working days to generate your prescription.

HRT Questionnaire
Have you had any problems or concerns with your HRT? *
Do you have breast tenderness or changes? *
Do you examine your breasts regularly? *
Are you up to date with the recommended screening programs, e.g. smears, breast screening over 50? *
Do you feel nauseous (sick)? *
Do you have headaches? *
Do you have any bleeding which is abnormal? *
Do you smoke? *
How often do you have an alcoholic drink? *
How many standard* alcoholic drinks do you have on a typical day when you are drinking (*A standard alcoholic drink is 1 unit of alcohol = a small glass of wine, a pub measure of spirits or half pint of lager/beer) *
How often do you have 6+ standard alcoholic drinks on one occasion? *
Do you want to speak to your GP or Pharmacist about your HRT medication?

Extended Access is the offer of pre-bookable appointments outside GP practices’ core contractual hours, either in the early morning, evening (until 9.30pm) or at weekend and on bank holidays.

There are a range of appointments we can offer our patients in addition to practice appointments, please speak to our reception team for more information.

If you need medical assistance whilst we are closed, please call NHS 111 or access information online Get medical help – NHS 111

For life threatening emergencies – Call 999 for an ambulance

For urgent dental treatment: call your dentist or  call the Lancashire and South Cumbria Dental help line number 0300 1243 010. The helpline will assess dental needs and if urgent signpost to relevant service.

The online consult service has clinically approved , GP-authored information covering a number of topics with self-help videos and resources. Submit a routine query and we will respond in two working days.