Contraceptive Pill Review

If you take a combined contraceptive pill (one you take for 21 days and then have a 7 day break from) it is vital for the safe issue of your medication, that we have an up to date blood pressure and weight reading. These can be done on the machine in our reception. Without these we cannot safely issue your pill.

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

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

Have there been any recent changes in your family medical history?
Smoking Status:

Please provide a blood pressure reading.

Please use this date format: DD/MM/YYYY.
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