Contraceptive Pill Review

If you have been advised by the practice to complete a Contraception 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.
Do you currently smoke?
Have you smoked in the past?
How many cigarettes did you smoke in a day?
How many cigarettes do you smoke in a day?
Would you like to give up smoking?

Your Blood Pressure

Please provide your most recent blood pressure reading, if you have a monitor.


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