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

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

Do you have problems forgetting to take your pill
Have you ever had a stroke, a blood clot in your lungs or legs, a heart attack or any heart problems?
Have your mother, father, brother or sister had any of the above aged under 45 years?
Has anyone in your family had cancer of the womb (uterus) or breast?
Have you been given information about long acting reversible contraceptives (Implants, Coils or Injections)?
I give my consent for SMS text messaging *