This form is for women already established on HRT. To ensure patient safety, please complete all questions. Please note we cannot process prescription requests without an up to date height, weight and blood pressure – this is for patient safety reasons. Once your prescription has been processed, a 12 month supply of your medication will be issued – please ensure you collect the total balance from the pharmacy.
Please read information on blood clots.
If a prescription is not issued we will contact you to let you know.
