Contraceptive Pill Review

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

Contraceptive Pill Review

Contraceptive Pill Review

About You

In Metres
In KG
Systolic "Higher"/ Diastolic "Lower"/ Heart Rate
Smoking Status:
Are you interested in advice on how to quit?

Contraception Pill Review

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

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

Please book an appointment to see the practice nurse

Have you missed any contraceptive pills?
Do you know about emergency contraception?
Do you know when and how to access these?