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Foundation Surgery NHS GP surgery

Epilepsy review

Epilepsy

Form summary

Epilepsy questions

Are you currently on treatment for epilepsy? *

Yes

How often do you have epileptic seizures? *

Never

Many seizures a day

Daily seizures

1 to 7 seizures a week

2 to 4 seizures a month

1 to 12 seizures a year

How long has it been since your last epileptic seizure? *

Within the last week

1 to 4 weeks

1 to 6 months

6 to 12 months

Over 12 months

Does your epilepsy impact your education? *

Yes

Not applicable

Does your epilepsy impact working? *

Yes, it restricts working

Yes, it prevents me from working

Does your epilepsy limit your activities? *

Yes

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

Yes

Not applicable

Find out more about living with epilepsy (opens in new tab)

Is there anything you would like to discuss? *

Yes

For example, changes in mood, memory loss, dizziness, tiredness, weight change, cognitive impairment, sleep

Provide details about what you would like to discuss *

Terms and conditions *

I confirm that this is not an emergency and understand the surgery cannot help while it is closed. If I need help right now, I will use the NHS 111 service. In an emergency, I will call 999 or go to A&E.

If you are human, leave this field blank.

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