New patient health questionnaire

• Please note that it is the practice policy that we do not prescribe regular benzodiazepine medication or sleeping tablets. (examples include - Diazepam, Nitrazepam, Temazepam, Zopiclone and Zolpidem)
• It is our practice policy for all new patients to be reviewed.
• All patients (without exception) who are taking the above medication will be started on a reduction program until the medication is stopped. This will be done in a controlled way following local health board guide lines.
• It is the patient’s responsibility to provide evidence of any current medication from their previous practice.

By signing the following, you are requesting to join the practice as a patient and are agreeing to comply with the above Benzodiazepine policy if applicable.