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.
Responses we send will go to this email address

Contraception Pill Review

Have you missed any pills?
Do you smoke?
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

Since your last pill check, have you or any of your close family suffered from venous thrombosis or a pulmonary embolism?

Please book an appointment to see the practice nurse

Is your weight steady?
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