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

Have you been asked by the practice to complete this online review? *
Please do not fill this form in until you have been asked to complete it by the GP surgery. If you have not been asked to submit this form, you will need to discuss it with the surgery first.

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