Generic Consultation – Sleeping Aids

2. About your Condition

To help us understand that this treatment is the right option for you, please answer the following questions.

Is this a repeat prescription?

Yes

Is there anything else which you feel we should know about prior to you taking this medication?

Yes

3. The Agreement and Consent

Please answer the following questions to help us confirm that you'll follow the guidelines for this medicine.

Do you agree to the following?

You declare that I have answered the above truthfully
You will read the patient information leaflet before taking your medication (if prescribed)
You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment
You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
You understand that this questionnaire is part of a request to the doctor and the final decision will rest with the doctor

Yes

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