Are you currently taking all of your prescribed medication?

Are you confident with how to take your medication?

Have you had any side effects or problems since starting your medication?

Are there times when you miss or forget your medication?

Do you take any other medication - prescribed elsewhere or bought (including any supplements or herbal remedies)?

Do you have any concerns or questions about your medication which you would like to discuss with a health care professional?

I consent to my information being used for the purposes described above and wish to submit this online form to Nelson Surgery • Bryncelyn, Nelson, Treharris, CF46 6HL.