The Avenue Surgery

14-16 The Avenue, Warminster, Wiltshire, BA12 9AA

Telephone: 01985 224600

Emergencies when closed: 111

Menu

Home
Appointments
Prescriptions
New Patients
Services
Team
Self Help
Practice Info
Practice Info

Our staff are committed to providing quality healthcare for the benefit of all of our patients.
Find out more
Policies
News
Contact Us

Home
Appointments
Prescriptions
New Patients
Services
Team
Self Help
Practice Info
News
Contact Us

Epilepsy Review Form

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

Epilepsy Review

If you are human, leave this field blank.

About You

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Phone Number:

Email Address:

Epilepsy Review

How long has it been since your last epileptic fit?

Within the last week

1 to 4 weeks

1 to 6 months

6 to 12 months

Over 12 months

Are you currently on treatment for epilepsy?

Yes

No

How often do you have an epileptic fit?

None

Many seizures a day

Daily seizures

1 to 7 seizures a week

2 to 4 seizures a month

1 to 12 seizures a year

Are you a woman aged between 18 and 55?

Yes

No

Would you like some information regarding contraception, conception and pregnancy and how this is affected by your epilepsy medication?

Yes

No

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

reCAPTCHA

Sending

Online Services

Blood Pressure Review Form
Epilepsy Review Form
Patient Group Sign-up Form
Register a Carer
Smoking Review Form
Summary Care Opt-Out Form
Travel Risk Assessment Form

Services

Chronic Disease Management

Anticoagulant Clinic (Warfarin)
Diabetes
Heart Disease
Hypertension
Respiratory Disease

Sexual Health & Family Planning

Sexual Health
Contraception
‘No Worries!’ – Sexual Health for 13 to 24 year olds

Keeping Healthy

Smoking Cessation
Blood Tests
Mental Health

Other Services

Minor Injuries
External NHS Services
Travel Clinic
Minor Surgery

Review Forms

Asthma
Blood Pressure
Breathlessness
Epilepsy
Sick Note
Smoking
Travel Risk Assessment

Policies

Access To Medical Records
Safeguarding Adults Policy
CCTV Images & Telephone Call Recording
Confidentiality
Change Of Details
Freedom Of Information
IT Statement of Intent
Suggestions & Comments
Zero Tolerance

Useful Links

Useful External Websites

© The Avenue Surgery

Sitemap
Site Credits
Privacy Statement
Disclaimer
Copyright
Accessibility