Contraceptive Pill Review

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

Please ensure you check your Spam/Junk email folder for any replies. An appointment/reply will be sent back to you via an email.

Contraceptive Pill Review

Contraceptive Pill Review

About You

eg. 1.75
eg. 60.6
Please note: BMI calculator is only for patients aged 18 and over.
In format: Systolic "Higher" / Diastolic "Lower"
Do you smoke?
Would you like to arrange an appointment for smoking cessation?

Contraception Pill Review

Do you regularly check your breasts?

Please ask reception for our information regarding the importance of regular breast self-examination.

Do you suffer from severe headaches or migraines?

Please make an appointment to see your doctor to discuss your headaches if you have not already done so.

Are you experiencing any irregular bleeding?

Please book an appointment to see the practice nurse