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

Section

Contraception Pill Review

In Metres
In KG
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

Blood Pressure

Please provide a BP reading if known.

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

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Smoking

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