Keith Health Centre

Turner Street, Keith, AB55 5DJ

Telephone: 0345 337 9944 | Prescriptions: 01542 881001

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Vacancy for a salaried GP (6-8 sessions) Backscanning of GP Paper Notes Antibiotic Amnesty Unused medicine – the costs in NHS Grampian

News

Vacancy for a salaried GP (6-8 sessions)

Posted on July 2nd, 2025

Click on the following link to see details of our latest vacancy: KHC – GP Advert August 2025

Backscanning of GP Paper Notes

Posted on June 17th, 2025

Important information for patients In keeping with other GP practices, Keith Health Centre is currently backscanning all GP paper records […]

Unused medicine – the costs in NHS Grampian

Posted on July 30th, 2024

Please watch the videos below and click on the link to the NHS Grampian website to learn about the huge […]

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Hormone Replacement Therapy (HRT) Review Form

Opening Times

Monday
08:00am to 06:00pm
Tuesday
08:00am to 06:00pm
Wednesday
08:00am to 06:00pm
Thursday
08:00am to 06:00pm
Friday
08:00am to 06:00pm
Saturday
CLOSED
Sunday
CLOSED

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Hormone Replacement Therapy (HRT) Review Form

I confirm that I am a registered patient at Keith Health Centre.(Required)
Yes
Name(Required)
First Last
Date of Birth(Required)
MM slash DD slash YYYY

Email(Required)

Contact telephone number(Required)
Address(Required)
Street Address City County / State / Region Postcode Country

Please tell us the type of hormone replacement therapy (HRT) you are using, including the name and dose, if known(Required)
Do you have a hormonal coil in place? eg Mirena, Jaydess or Kyleena coil(Required)

Yes

No

Not sure
If you answered YES to the previous question, if known, please tell us the type of coil and when you had it fitted
How long have you been taking hormone replacement therapy (HRT)?(Required)
Do you have any problems with your HRT?(Required)

Yes

No
If you answered YES to the previous question, please tell us more about the problems you have with your HRT.
Do you ever miss or forget to take your HRT?(Required)

Yes

No
If you are taking HRT in separate preparations, it is important, for safety reasons, to take both as prescribed.
Does your HRT control your hot flushes?(Required)

Yes

No

Somewhat

I don't have hot flushes
Does your HRT control your mood problems?(Required)

Yes

No

Somewhat

I don't have mood problems
Does your HRT control our vaginal dryness?(Required)

Yes

No

Somewhat

I don't have vaginal dryness
Are you sexually active?(Required)

Yes

No
Do you have any pain or discomfort during sex?(Required)

Yes

No
If you ticked "Yes," please make a GP appointment to discuss.
Do you need contraception?(Required)

Yes

No
Have you had surgery to remove your womb (hysterectomy)?(Required)

Yes

No
If you answered YES to the previous question, when did you have a hysterectomy?
Do you have periods or bleeding on your HRT?(Required)

Yes

No
If YES, please describe your bleeding pattern. How often do you bleed, and is this regular?
Do you have any unexplained vaginal bleeding or a change in bleeding pattern?(Required)

Yes

No
Do you have any bleeding after sex?(Required)

Yes

No
Do you have any new breast symptoms?(Required)

Yes

No

Not applicable
Have you or any of your parent(s) sibling(s) been diagnosed with breast cancer?(Required)

Yes

No
If you answered YES to the previous question, please tell us which family member(s) have been affected by breast cancer.
Have you or any of your parent(s) or sibling(s) been diagnosed with a blood clot?(Required)

Yes

No

Don't know
Do you get headaches or migraines?(Required)

Yes

No
If you anwered YES to the previous question, have you recently had headaches or migraines?

Yes

No
If you answered YES to the previous question, how often do you get your headaches or migraines?
When you have a headache, do you have to take medication to make it better?

Yes

No
Do you get any visual symptoms, weakness or numbness associated with your headaches/migraines when they occur?

Yes

No
Please tell us your weight? (optional)
Please tell us your height? (optional)
Do you know your blood pressure reading from the last month?(Required)

Yes

No

No, but I had my blood pressure measured at the surgery
If yes, please provide your blood pressure reading with your systolic (upper) and diastolic (lower) values (for example: 120/80
Do you have any allergies?

Yes

No
If you answered YES to the previous question, please tell us what allergies you have:
Are you up to date with breast screening?(Required)

Yes

No

Not sure
Are you up to date with cervical screening?

Yes

No

Not sure
Is there anything else you would like to tell us that we have not asked? (Please answer below)
What is the best way for us to respond to this request for HRT? Please be aware that you may be called in for an HRT review from time to time, based on the answers to these questions.

Text - (supply up to date number below)

Email (supply email address)

Phone (supply phone number if different from above)
Contact Details (as requested above)
PLEASE READ THE FOLLOWING INFORMATION AND TICK THE BOX BELOW TO ACKNOWLEDGE YOUR UNDERSTANDING: Most women benefit from HRT in terms of health and quality of life. There are, however, some risks to HRT which should be considered. HRT can carry a small increased risk of breast cancer. It is important to take your HRT correctly, as prescribed, to protect the womb lining from thickening, which can increase the risk of cancer of the womb. There is also an increased risk of blood clots depending on the type of HRT prescribed and individual risk factors. Health benefitis and reduced risks can be gained by eating a healthy diet, regular exercise, not smoking, restricting alcohol consumption to recommended limits and maintainng a healthy weight where possible. It is also important to attend regularly for cervical smears and breast screening as indicatedand to be breast aware and examine your breasts regularly and report any changes to your doctor. If you would like to read more about the benefits and small risks of HRT, there are many websites offering advice eg www.menopausematters.co.uk or navigate to the women's health page on our website.(Required)

I have read and understood the risks described above.

Privacy Policy and Terms - This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the team to contact you and also to update your medical records. Please read our Privacy Policy to discover how we protect and manage your submitted data. I CONSENT TO THE PRACTICE COLLECTING AND STORING MY DATA FROM THIS FORM.(Required)

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