Hypothyroid Self Assessment

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Hyperthyroid Self Assessment

What is the Hyperthyroid Self Assessment?

For many people with an underactive thyroid (Hypothyroidism) taking thyroxine medication is a simple process of taking a standard and stable dose of pills every day for life.
Providing you are well and stable we may be able to monitor your health without you visiting the practice.

If this applies to you.

If this applies to you (and you are not on any other tablets requiring monitoring), then before your medication runs out please complete this assessment.
We will review whether we can repeat your medication for another 9-12 months.

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All questions marked with a * are mandatory

Personal Details

Gender at Birth: *

Do you Identity differently?:

Please double check you've entered the correct email address

May be used to identify you

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Hypothyroid Self Assessment

Have you had your blood tested for thyroid in the last 9 months?: *

Your Weight

What units or measurement are you using?: *

Conversion from Stones & Pounds to Kilograms

Are there any recent changes in weight?: *

Your Pulse

If it is less than 60 or above 80 when resting please discuss this with your doctor

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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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