Contraceptive Pill Review

If you have been advised by the surgery to submit a contraceptive pill review please use this form. Please note blood pressure and weight are mandatory fields on this form. You can have your blood pressure taken at your local pharmacy. If you do not have both your blood pressure and weight available please contact the practice for an appointment with a Nurse.

Last Updated: 30/11/2023

Your Details

BP reading

Please note we are unable to complete a contraceptive pill review without a recent BP reading. If you do not have a recent BP reading please come to surgery to use the BP machine in the waiting room or contact reception to book a face to face pill review. 

Family History

Have you, or any of your immediate family (mum, dad, brothers, or sisters) been diagnosed with any of the following conditions within the past 12 months?

Your Medical History

Have you been diagnosed with or experienced any of the following conditions in the past 12 months?

Current Medication

Are you currently taking any of the following medications? 

Contraceptive Pill Review

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