Make a request for Shared Care

Been on a stable dose of medication with Noodle for over 8 weeks? Complete this form, filling in every section, to request Shared Care.

Unfortunately, we can’t influence how long it takes your GP to make their decision. Click the button below if you'd like to request medication.

Request medication

Please read our privacy notice before you complete this form

We'll use these details to check whether Shared Care is suitable, and to contact your GP using the email you give us so they can consider taking over your prescribing. We'll send your GP the information needed, including your medication and health monitoring results. This will also be added to your clinical record. Please check your GP's email address is correct before you submit.

Noodle is responsible for your information. We share it only with the providers that help us run this service and with anyone else mentioned above. You have rights over your information, including the right to access or correct it. You can raise a concern with us by email or with the ICO. Read our Privacy Policy.

First Name (required)

Last Name (required)

Email (required)

Your GP's Email (required)

Date of Birth (required)

Reason for Contact (required)

The Approximate Date You Started Your Stable Dose of Medication (required)

Physical Health Monitoring

Blood Pressure (Systolic mmHg) (required)

Please provide an up to date Systolic (mmHg) blood pressure reading. This is for your clinical safety.

Blood Pressure (Diastolic mmHg) (required)

Please provide an up to date Diastolic (mmHg) blood pressure reading. This is for your clinical safety.

Pulse (bpm) (required)

Please provide an up to date pulse reading. This is for your clinical safety.

Weight (kg) (required)

Please provide your current weight in Kg. This is for your clinical safety.

Medication One

Medication Name (required)

Dosage (required)

What is your current dosage of this medication? (For example, 50mg, 30mg, 2x30mg)

When Do You Take This Medication? (required)

Medication Two

Medication Name

Dosage

What is your current dosage of this medication? (For example, 50mg, 30mg, 2x30mg)

When Do You Take This Medication?

Medication Three

Medication Name

Dosage

What is your current dosage of this medication? (For example, 50mg, 30mg, 2x30mg)

When Do You Take This Medication?

Please confirm that you are a current Noodle client who has been under the care of our medication team (required)I confirm

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Make a request for Shared Care