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


Contraception Pill Review

In Metres
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? *

Blood Pressure

Please provide a BP reading.

If you do not have a machine at home, we also have lifestyle machines available in the health centre or Caxton Villa.



Smoking Status: *
Are you interested in advice on how to quit? *