Contraceptive Pill Review

If you have been advised by the surgery to submit a contraceptive pill review please use this form.

If you have any concerns about your contraception, please make an appointment with a GP or nurse.

Please Note – once you have submitted this information, any reply or acknowledgement from us will be sent to the email address you provide at top of the form. This response may include personal and sensitive information about you. We therefore strongly advise that you provide a personal email address that only you have access to. If you do not wish for us to communicate with you via email, please do not use this form and call us instead.

Contraceptive Pill Review

Contraceptive Pill Review

About You

Please use this date format: DD/MM/YYYY.
This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.

Contraception Pill Review

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

Please make an appointment to see your doctor to discuss your headaches if you have not already done so.

Please book an appointment to see the practice nurse

Blood Pressure

Please complete your most recent blood pressure reading below.
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