Stopping Medication

It’s important that your medical records are up to date and that you inform us if you have stopped taking any repeat medication. Please use this form to tell us if you are no longer taking a medication and the reason why.

Required field(s) are indicated by *
Stopping Medication
About you

First Name(s) as appears on your passport.

Last Name(s) as appears on your passport.

The one used to register with your GP.

Your date of birth is required to verify your identity.

As on your medical record.

The practice may use this number to contact you about your request.

This email address can be used to contact you about your request. Please be aware that if you have given anyone else access to your email account they may see responses sent to you.

Please continue completing the form below

We will only use this email address for correspondence in relation to this request and will not sell it onto third parties.

Stopping Repeat Medication

Repeat Medication Stopped

Repeat Medication Stopped

Repeat Medication Stopped

Repeat Medication Stopped

Repeat Medication Stopped

Repeat Medication Stopped

Repeat Medication Stopped

Repeat Medication Stopped

Repeat Medication Stopped