Antidepressant Medication Review Form

After submitting this form, please kindly remember to fill in the symptom questionnaire forms too.

Antidepressant Medication Review Form

Please give details of your name, date of birth and name of the medication we are to review. *

How regularly are you able to take the medication? *

Please describe below any new or ongoing side effects on your current medication . *

How well do you feel the medication is helping with mood and anxiety levels? *

How do you manage with day to day activities ? Specifically, Please describe, in the last few months, how much does your condition currently affect your work and home life. *

Do you wish to continue with the current regime, change dose or thinking you are ready to come off the medication? *

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Page last reviewed: 12 May 2022

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Antidepressant Medication Review Form

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