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Registered UK pharmacy · GPhC [0000000] · Prescriber-led consultations

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Consultation

Evorel (HRT Patches)

A prescriber reads every answer. Answer honestly: a wrong answer here is not a shortcut, it is the thing that makes a medicine unsafe for you.

  1. 1About your health
  2. 2About this treatment
  3. 3About you

Allergies

Do you have any allergies to medicines? *
Which medicines, and what happened? *

Current Medications

List any medicines you take, including anything you buy without a prescription. *

Medical History

Are you being treated for any long-term condition? *
Which conditions? *
Are you currently established on HRT? *
Which form of HRT Do you use? (Select all that apply) *
What is the name and strength of your current HRT? *
Does your HRT include a progestogen/womb-protection hormone? *
Have you had your womb/uterus removed? *
If you have had a total hysterectomy, have you ever had endometriosis? *
What bleeding pattern do you have on your current HRT? *
Have you had any unexpected or unscheduled vaginal bleeding? *
Do you have, or have you ever had, breast cancer, or do you take letrozole, anastrozole or exemestane? *
Have you ever had endometrial/womb cancer or ovarian cancer? *
Do any of the following apply: current/recent blood clot, major surgery in the last 3 weeks, or currently immobile/bed-bound/in a cast? *
Have you had a review of your HRT with a clinician in the last 12 months? *
What sex were you registered at birth? *
Are you experiencing vaginal dryness? *

Current Medications

If you take a separate progesterone/progestogen tablet, how do you take it? *
Are you taking lamotrigine, carbamazepine, phenytoin, rifampicin, St John’s Wort, or any other enzyme-inducing medicine? *
Is there anything else you would like the prescriber to know, including changes in health, new medicines, side effects, or concerns about your HRT? *

Lifestyle

Do you smoke? (Including vaping products) *

Your answers are seen by the prescriber reviewing your order and the dispensing pharmacist. They are not used for marketing.