HRT Review

If you have been advised by the surgery to submit a HRT review, please use this form.

Please ensure when requesting repeat medication you have enough to last 2 weeks from the date you submit your request. Repeat medication requests will take 14 working days to be processed/approved/re-issued by a Clinician.

HRT Review

HRT Review


Blood Pressure

If you do not have a blood pressure monitor to take your own reading, please contact the surgery via the Request an Appointment with a Nurse or Healthcare Assistant form. We require this form to be completed, together with your blood pressure reading before a repeat HRT medication can be issued by a clinician.

Please use this date format: DD/MM/YYYY.

You can get your blood pressure reading taken at a local pharmacy.

Rhythm of pulse:
Weight Measurements:
Smoking status
Have you been experiencing side effects since starting HRT?
Have you experienced any persistent unexpected bleeding or increased bleeding?
Are you aware about the increased risk of blood clots and some cancers associated with HRT?

Please visit to read about the risks of Hormone replacement therapy (HRT)

Do you regularly self-check your breasts?

Please visit to read about how to check your breasts

Please advise exactly how much HRT you have left when requesting your repeat prescription. Please be specific with duration (e.g. How many days).

Have you had a full review within the last year?