Contraceptive Pill Review

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

We need to make sure that your contraception choice is still suitable for you. Depending upon your answers on the form, we may need to contact you for a review. If you are over 40, please book a call with your doctor to discuss your ongoing treatment, rather than filling in this form.

Contraceptive Pill Review

Contraceptive Pill Review

About You

Please use this date format: DD/MM/YYYY.
If known, please use metric.
If known, please use metric.

Contraception Pill Review

Please book an appointment to see the practice nurse

Blood Pressure

We need a blood pressure from you every year. Please enter it here if you have a BP machine at home. If not, please use the BP machine in our waiting room and enter it here, or hand the results to the patient advisor team.
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