Thank you for taking the time to complete the online medication review form. We are currently trialling this way of working to see if we can help to create more capacity for patient appointments with the GP. The GP will review all completed medication review forms. However, please be aware that you may still be required to attend an appointment for a medication review if the GP thinks that this is necessary.
Please do not use this form for any other medical queries either routine or urgent.
The form includes information on alcohol consumption. The following link is a useful guide on calculating on many units of alcohol you may consume.
Alcohol units - NHS (www.nhs.uk)
Complete all questions on this form
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure
connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to
Great James Street Health Centre, Great James Street, Derry, BT48 7DH.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.