Antidepressant Medication Review Form

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

Last Updated: 12/05/2022

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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Antidepressant Medication Review Form

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