Epilepsy Review

Form only to be completed if requested by the practice.

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

Epilepsy Review

Epilepsy Review

Epilepsy Review

How long has it been since your last epileptic fit?
Are you currently on treatment for epilepsy?
How often do you have an epileptic fit?
Are you a woman aged between 18 and 55?
Would you like some information regarding contraception, conception and pregnancy and how this is affected by your epilepsy medication?

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

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