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HRT Prescription Start Questionnaire

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Appointment Information

Please would you complete this questionnaire regarding your recent HRT Appointment with Dr Ellie Rejzl and Louise Greaves.

Feedback from this survey will help the development of this service and your opinions are therefore very valuable.

Questionnaire

Making me feel comfortable and putting me at ease: *

Please select the option that best fits the statement above.

Understanding me as a whole person and how my health may impact my life: *

Please select the option that best fits the statement above.

Listening to me and respecting my thoughts and expectations about my health and treatment: *

Please select an option that fits the description above

Finding out and involving my wishes when decisions are made about my health or medication: *

Please select the option that best fits the statement above.

Giving me clear, easy-to-understand information about my medication: *

Please select the option that best fits the statement above.

Supporting me in ensuring that I take my medication as prescribed: *

Please select the option that best fits the statement above.

Telling me where to get further information about my medication and treatments if needed: *

Please select the option that best fits the statement above.

Ensuring that I know what to do if I have any concerns or become more unwell: *

Please select the option that best fits the statement above.

Encouraging me to be responsible for my health and self-care when appropriate: *

Please select the option that best fits the statement above.

Overall, how would you rate your consultation with this IP student today?: *

Please select the option that best fits the statement above.

Privacy Consent

This form collects personal and medical information about you and we use this information to allow the practice team to contact you.
Please read our Privacy Policy to discover how we protect and manage your submitted data.

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Veteran Friendly

Armed Forces veteran
friendly accredited
GP practice

Vitality Partners of Park Run

Proud to be a
parkrun practice

WEB

Primary Care Network

Providing NHS Services

Contact

Budleigh Salterton Medical Centre
1 The Lawn
Budleigh Salterton
Devon
EX9 6LS

Telephone: 01395 441 212

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