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Medication review form: depression & anxiety

This online review form is for patients who take anti-depressant / anti-anxiety medications (fluoxetine, citalopram, sertraline, paroxetine, venlafaxine or mirtazapine) for the treatment of depression and/or anxiety and are happy with their medication. If you’re not happy with your medication, want to change the dose of your medication, or would like to discuss a plan for stopping the medication, please phone for an appointment instead.

We may be able to add your medication to your repeat prescription or re-authorise your existing repeat prescription after you fill out this form. This will allow us to more efficiently deal with future prescription requests and may save you needing to call the Practice to book a review appointment.

SSRI review
Are you taking fluoxetine, citalopram, sertraline, paroxetine, venlafaxine or mirtazapine for the treatment of depression and/or anxiety?

Please don’t fill in this form. If you’re taking fluoxetine, citalopram, sertraline, paroxetine, venlafaxine or mirtazapine for any reason other than anxiety and/or depression and need to discuss your medication with us, please call us on 0300 790 6266 Monday-Friday from 8am.

Have you been asked to fill out this form by someone at Riverside Medical Practice, or been sent a text message asking you to do so?
If someone at the Practice hasn’t asked you to complete this form – or you haven’t been sent a text message asking you to do so – please don’t carry on filling in this form. Please call us on 0300 790 6266 Monday-Friday if you need help with your mental health or 111 outside of these hours.
Are you happy to continue with the current dose of your anti-depressant or anxiety medication?
Please don’t carry on filling in this form. Please call the Practice on 0300 790 6266 from 8am Monday-Friday to discuss any mental health concerns and your medication.

To speak to someone about your mental health, you can also contact:

  • CWIC Mental Health Team: 0300 790 6292 (Mon-Fri 9am-4pm)
  • Breathing Space Scotland: 0800 83 85 87 (Mon-Thurs 6pm-2am, Fri 6pm-Mon 6am)
  • Samaritans: 116 123 (24 hours)
  • NHS 24: 111 (24 hours)

If you have a mental health emergency please call 111 or attend A&E.

Do you feel able to keep yourself safe?
Please don’t carry on filling in this form. Please call the Practice on 0300 790 6266 from 8am Monday-Friday to discuss any mental health concerns and your medication.

To speak to someone about your mental health, you can also contact:

  • CWIC Mental Health Team: 0300 790 6292 (Mon-Fri 9am-4pm)
  • Breathing Space Scotland: 0800 83 85 87 (Mon-Thurs 6pm-2am, Fri 6pm-Mon 6am)
  • Samaritans: 116 123 (24 hours)
  • NHS 24: 111 (24 hours)

If you have a mental health emergency please call 111 or attend A&E.

Is your anti-depressant or anxiety medication helping with your mood and anxiety levels?
Please don’t carry on filling in this form. Please call the Practice on 0300 790 6266 from 8am Monday-Friday to discuss any mental health concerns and your medication.

To speak to someone about your mental health, you can also contact:

  • CWIC Mental Health Team: 0300 790 6292 (Mon-Fri 9am-4pm)
  • Breathing Space Scotland: 0800 83 85 87 (Mon-Thurs 6pm-2am, Fri 6pm-Mon 6am)
  • Samaritans: 116 123 (24 hours)
  • NHS 24: 111 (24 hours)

If you have a mental health emergency please call 111 or attend A&E.

Are you experiencing any side-effects from your anti-depressant or anxiety medication, which bother you?
Please don’t carry on filling in this form. Please call the Practice on 0300 790 6266 from 8am Monday-Friday to discuss any mental health concerns and your medication.

To speak to someone about your mental health, you can also contact:

  • CWIC Mental Health Team: 0300 790 6292 (Mon-Fri 9am-4pm)
  • Breathing Space Scotland: 0800 83 85 87 (Mon-Thurs 6pm-2am, Fri 6pm-Mon 6am)
  • Samaritans: 116 123 (24 hours)
  • NHS 24: 111 (24 hours)

If you have a mental health emergency please call 111 or attend A&E.

Are you taking your anti-depressant or anxiety medication regularly?
Please don’t carry on filling in this form. Please call the Practice on 0300 790 6266 from 8am Monday-Friday to discuss any mental health concerns and your medication.

To speak to someone about your mental health, you can also contact:

  • CWIC Mental Health Team: 0300 790 6292 (Mon-Fri 9am-4pm)
  • Breathing Space Scotland: 0800 83 85 87 (Mon-Thurs 6pm-2am, Fri 6pm-Mon 6am)
  • Samaritans: 116 123 (24 hours)
  • NHS 24: 111 (24 hours)

If you have a mental health emergency please call 111 or attend A&E.

Please use format day/month/year eg 12/05/1979
I understand that I need to let the Practice know, if anything changes between now and when I next order this medication
Have you found this form more useful than the old system, where you needed to call us to book a GP appointment if you needed a medication review?
We may text you after reviewing your review form and will use the mobile number on your patient record. If we don’t have a mobile number for you (or you’ve recently changed mobile number) please fill in our change of contact details form.

Privacy policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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