HRT Review Form

HRT Review Form

Important: this form is changing from 1 August 2026

From 1 August 2026, HRT requests will move to MedLink, our new system for online reviews.

Until then, you can keep using the form on this page as normal.

 

For more on why we're making this change, see Important changes to our website and online forms.

  • Your Details

    Date of Birth
    For example, 15 3 1984

  • HRT Review

    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.
    Are you currently prescribed Mounjaro (Tirzepatide) or Wegovy (Semaglutide) privately for weight loss?
    Smoking Status
    Have you ever had a blood clot, stroke, heart disease, or major illness?
    Since your last HRT review have you experienced any unexpecte bleeding? Including: bleeding after sex; bleeding between your periods; or (if your periods have stopped) any bleeding more than 12 months after your last period.

  • Blood Pressure

    If you are not able to find a way of measuring your blood pressure in the community, please contact the surgery and arrange an appointment with one of the CTAC nurses.     

    If you on HRT which contains Estrogen a blood pressure is a requirement to ensure safe prescribing of this medication

  • Please take some time to read the information in the links below regarding the risks and benefits of HRT

     

    Each link will open in a new tab or window to allow you to come back to this form to continue.

     

    Please confirm you have read about and understand the risks and benefits of taking HRT. (optional)

  • Comments

  • Text Messaging

    We may text you after reviewing your HRT form and will use the mobile number on your patient record. If we don't have a mobile number for you (or you've recently changed mobile number) please fill in our change of contact details form.

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Page last reviewed: 13 July 2026
Page created: 20 November 2023