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.
Any responses we send will go to this email address.

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

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