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PSM Medical Group

PSM Medical Group

St Mary's Health Centre, Cop Lane, Penwortham, Preston, PR1 0SR

Telephone: 01772 970079 (Please note - area code must be dialled, even for local calls)

lscicb-gp.psm@nhs.net

We are currently closed. If you call us between 18:30-20:30 weekdays, 09:00-17:00 on Saturdays and 09:00-12:00 on Sundays your call will automatically forward to our 'Increased Access' out of hours service where you can book 'on-the-day' GP and Practice Nurse appointments at one of our other network sites in Preston. For more information on this service go to https://greaterprestonpcn.nhs.uk/increased-access-to-primary-care

See our other locations

UCLan Medical Centre, Foster Building, UCLan Campus, Preston, PR1 2HE | Telephone: 01772 970079

Mounjaro (Tirzepatide) update Lancashire Breast Screening Invitations GPs on your side

Topiramate declaration form

Topiramate Pregnancy Prevention Programme

Information for Patients Topiramate is one of a range of effective medicines for the prevention of migraine. As with all medicines it has risks as well as benefits. If you take topiramate when pregnant it can seriously harm the baby. Children whose mothers take topiramate during pregnancy have a higher risk of: – Being born with birth defects – Mental development and learning problems, such as autism spectrum disorder and attention deficit hyperactivity disorder – Being smaller and weighing less than expected at birth (small for gestational age) Due to these risks, patients who can get pregnant must use effective birth control (contraception) at all times while taking topiramate. They must also follow the requirements of the Pregnancy Prevention Programme. This Annual Risk Awareness Form is to make sure you know about the risks of taking topiramate during pregnancy. Your healthcare professional will go through this form with you. You will receive a copy of the completed form – please keep the copy safe.

About You

Your Name(Required)

First Last

Date of birth (dd/mm/yyyy)(Required)

NHS Number (if known)

Please enter a number from 1000000000 to 9999999999.

Explain the risks and document awareness

Healthcare professionals and patients must both complete this section of the form. This records that you have discussed the risks of taking topiramate during pregnancy and the measures needed to reduce the risks. The patient must also sign the form to confirm they are aware of these risks.

I can confirm - I have read and understood the Topiramate leaflet on PSM Medical's website (link below for reference)(Required)

I confirm my understanding of this

Topiramate Pregnancy Prevention Programme

I can confirm - Their medication should be reviewed regularly (at least once a year). At this review your healthcare professional will decide with you whether topiramate continues to be the best treatment for you. This will take into account any change in your circumstances.(Required)

I confirm my understanding of this

I can confirm - Topiramate can cause serious harm to an unborn baby if taken by a mother during pregnancy. For babies of mothers who take topiramate while pregnant the risks are: • Around 4 to 9 babies in every 100 will have birth defects compared with 1 to 3 babies in 100 of mothers in the general population. • A 2-3 times higher risk of autism spectrum disorder, attention deficit hyperactivity disorder and intellectual disabilities compared with babies born to women without epilepsy not taking epilepsy medicines. • Around 18 babies in every 100 will be born small for gestational age compared with around 5 in every 100 babies of mothers in the general population.(Required)

I confirm my understanding of this

I can confirm - Need for a pregnancy test to exclude pregnancy before starting topiramate. Further pregnancy tests may be needed during treatment.(Required)

I confirm my understanding of this

I can confirm - Need to use effective birth control (contraception) at all times during treatment with topiramate and for four weeks after stopping topiramate.(Required)

I confirm my understanding of this

I can confirm - The importance of discussing any plans for a pregnancy with their healthcare professional as soon as they are planning pregnancy to ensure timely discussion(Required)

I confirm my understanding of this

I can confirm - In case of suspected or unplanned pregnancy, and patient is only taking topiramate to prevent migraine, they need to: • stop taking topiramate straight away. • contact their healthcare professional.(Required)

I confirm my understanding of this

I can confirm - copy of the Patient Guide has been offered(Required)

I confirm my understanding of this

Today's date (dd/mm/yyyy)(Required)

Online Medical or Admin request (Now live 07:30-18:30 weekdays)

Update your Details

Prescriptions

Online Appointment Booking

Patient Participation Group

Download Practice Leaflet

Friends & Family Test

Opening Times

Monday08:00am to 06:30pm
University of Lancashire Medical Centre closes at 6pm
Tuesday08:00am to 06:30pm
University of Lancashire Medical Centre closes at 6pm
Wednesday08:00am to 06:30pm
University of Lancashire Medical Centre closes at 6pm
Thursday08:00am to 06:30pm
University of Lancashire Medical Centre closes at 6pm
Friday08:00am to 06:30pm
University of Lancashire Medical Centre closes at 6pm
SaturdayCLOSED
See Increased Access page in Appointments section
SundayCLOSED
See Increased Access page in Appointments section

Useful Links

NHS App

NHS 111

Patient UK

Google reviews - See what our patients are saying

NHS A-Z Conditions

Live Well

Calculate your Heart Age

Check your Blood Pressure Reading

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Joining our PPG

In order to improve the service that you receive, we really appreciate the input and feedback of patients. For this reason, we have patient participation groups which enable you to give your feedback about the service we provide, as well as enabling us to share information on how the system is run and our plans for the future. There are two Patient Participation groups that exist, both one for our practice individually and one that works across multiple practices in the locality. We really encourage all of our patients to get involved with both groups, our own participation group helping to improve the management of our service specifically and the locality group helping to ensure that everyone is receiving the same level of health care, no matter what practice they are registered to.

Name*

First Last

Date of Birth*

Address*

Telephone (home)

Telephone (mobile)

Email