Epilepsy Review

If you have been advised by the surgery to submit a epilepsy review please use this form.

Epilepsy Review

Epilepsy Review

Section

Epilepsy Review

Please use DD/MM/YYYY
How often do you have an epileptic fit?
Are you currently on treatment for epilepsy?
Does your epilepsy mean having to take time off work or school?
What is your current driving status?
Are the DVLA aware of your condition?
It is important that you contact the DVLA immediately to make them aware of your medical condition.

It could result in a £1000 fine if you withhold this information.

You can fill in the online form on the gov.uk website.

If you are a woman of child-bearing age, would you like us to send you some information regarding contraception, pregnancy and how this is affected by your epilepsy medication?
Units per week
Amount of different types of drink representing more than one unit of alcoholAmount of different types of drink representing more than one unit of alcohol
Have you ever smoked? *
Do you smoke now? *
Join the millions of people who have used Smokefree support to help them stop smoking. From email and text, to our free app and lots of other support, you can choose what’s right for you. For more information visit the Smokefree website.

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