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Brook Square Surgery NHS GP Surgery in Scarborough

Epilepsy review

Epilepsy Review

What is your smoking status? *

Smoker

Ex-smoker

Never smoked

Would you like information to help you quit? *

Yes

How long has it been since your last epileptic fit?

Within the last week

1 to 4 weeks

1 to 6 months

6 to 12 months

Over 12 months

Are you currently on treatment for epilepsy?

Yes

How often do you have an epileptic fit?

None

Many seizures a day

Daily seizures

1 to 7 seizures a week

2 to 4 seizures a month

1 to 12 seizures a year

Are you a woman aged between 18 and 55?

Yes

Would you like some information regarding contraception, conception and pregnancy and how this is affected by your epilepsy medication?

Yes

Please make an appointment with a practice nurse to discuss this further.

I confirm that the information provided is accurate to the best of my knowledge

If you are human, leave this field blank.

Trafalgar House
41-44 Trafalgar Street West
Scarborough
YO12 7AS

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01723 360 098

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