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

In Metres

Blood Pressure


Contraception Pill Review

Any family history of Breast Cancer?
Do you regularly check your breasts?

Please ask reception for our information regarding the importance of regular breast self-examination.

Any family history of Thrombosis? (Blood clots)
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

Are you a smoker?

Take extra precautions for 7 days following any episode of vomiting or diarrhoea.