ADHD Medication - Physical Monitoring

ADHD Medication - Physical Monitoring

Use this form if you have been asked to take and submit your physical observations for monitoring of ADHD medication.

Click HERE to watch instructions on how to check your heart rate at home.

Click HERE to watch instructions on how to check your blood pressure at home.

Your Details

Name

Date of Birth
For example, 15 3 1984

Day

Month

Year

Phone Number (Optional) (optional)

Email Address

Do you receive a regular prescription for Attention Deficit Hyperactivity Disorder (ADHD) medication from the GP at this surgery?

Yes

No

Current weight (kg):

Heart rate (number of pulse beats in 1 minute) - see video link at top of form for instructions

Blood pressure - see video link at top of form for instructions - enter your readings as two numbers e.g. 120 / 80

I UNDERSTAND THAT THIS FORM COLLECTS MY NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM I AM REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT ME AND ALSO TO UPDATE MY MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA.

Yes

No

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Page last reviewed: 15 December 2025
Page created: 05 November 2025