Epilepsy Review

If you have been advised by the surgery to submit an epilepsy review please use this form.

If you have been sent a blood test form your review will only be completed when all the information is complete.

A clinician will contact you ONLY if further action is required. If you take medication this will be reviewed. Your repeat medication will be updated in order that you can continue to get your tablets via your nominated pharmacy.

Please contact the surgery if you feel you have any concerns that need discussing.

Please only complete this form if asked to by a clinician.

Epilepsy Review

Epilepsy Review

Registered practice: *


Epilepsy Review

How long has it been since your last epileptic fit? *
Are you currently on treatment for epilepsy? *
How often do you have an epileptic fit? *
Are you a woman aged between 18 and 55? *
Would you like some information regarding contraception, conception and pregnancy and how this is affected by your epilepsy medication?

Please make an appointment with a practice nurse to discuss this further.