Hypothyroid Self Assessment Form
For many people with an underactive thyroid (Hypothyroidism) a the daily medication of thyroxine is a simple way to keep the thyroid stable. If you are well and stable we may be able to monitor your health through these assessments and not need a regular face to face consultation.
If you are not on any other medication that needs to be monitored, complete the assessment below before your medication runs out. We can then review the information and determine if we can repeat your medication for another 9 to 12 months.
You can also use accuRx to submit an online assessment.
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This information is not shared with any third party organisations.
This information is retained for up to 28 days.
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Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.