Epilepsy Review

Patients should only complete this form if advised to do so by a clinician.

Epilepsy Review

Epilepsy Review

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.

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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