HRT Review Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Please read all the information provided under the links NHS Inform – HRT GuideHRT increases your risk of breast cancer. Please read this leaflet carefully. HRT and breast cancer – MHRA information leafletHave you read links above *YesNoPersonal DetailsName *FirstLastDate of Birth *Please complete this form as part of your HRT review if you have been asked to do so. You will need an up to date blood pressure reading before you complete the online details.HRT ReviewYour blood pressureIf you do not have access to a blood pressure monitor please contact your community pharmacy or make an appointment with any of our practice nurses or phlebotomist.Your heightYour weight in kgDo you smoke? *YesNoHave you ever had a blood clot, heart disease, stroke, cancer, migraine or major illness? *YesNoIf yes then please give detailsAre you still in need of contraception? *YesNoHRT is not contraception. If under 55 you may need contraception.Have you had a hysterectomy? *YesNoDo you have a coil with hormone in it such as a mirena coil? *YesNoDo you understand and have you read about all the risks of taking HRT including the increased risk of breast cancer, stroke and deep vein thrombosis? *YesNoBest number if we need to contact you.Submit