Mental Health Medication Review Form

Last Updated: 17/01/2024

Important information

** If you are feeling SUICIDAL OR HAVING THOUGHTS OF HARMING YOURSELF OR OTHERS THEN DO NOT COMPLETE THIS FORM but contact the practice as soon as possible on 0131 4476277. You may wish to contact the EDINBURGH CRISIS LINE on 0808 801 0414 which is a 24/7 service.

** If you are planning to become pregnant or currently pregnant then please speak to your GP about your medication, also please see the section on our website about mental health and pregnancy

Your Details

Name *

Date of Birth *

Phone Number

Email Address *

MEDICATION INFORMATION

Name of medication *

What dose of medication do you currently take? *

Do you take your medication every day? *

Yes No

Are you satisfied with the benefits of your medication? *

Yes No

Are you experiencing any troublesome side effects from your medication? *

Yes No

If you would like to change your dose of medication please book an appointment to speak to a member of our clinical team *

Are you currently engaged in any other mental health therapies (eg: counselling, exercise programme)? please state in the text box below *

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Mental Health Medication Review Form

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