Hormone Replacement Therapy (HRT)

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This online form is for patients who are thinking of starting hormone replacement therapy (HRT)

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All questions marked with a * are mandatory

Personal details

If you are changing your name, this would be the name we current have for you

Please double check you've entered the correct email address and you have used your current email address

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Privacy Consent

This form collects personal and medical information about you and we use this information to allow the practice team to contact you.
Please read our Privacy Policy to discover how we protect and manage your submitted data.

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