Contraceptive Pill Review

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

If you are human, leave this field blank.

About You

Full Name: *

Phone Number:

Contraception Pill Review

Do you regularly check your breasts?

Yes

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

Do you suffer from severe headaches or migraines?

Yes - But the Doctor is unaware

Yes - But the Doctor is aware

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?

Yes

Please book an appointment to see the practice nurse

I confirm that the information provided is accurate to the best of my knowledge

Important -

Any forms received after 13:00 on 24/12/20 will not be actioned until Tuesday, 29th December. We apologise for any inconvenience. For urgent medical issues please visit 111.n... Find out more

Important -

The first phase of the NHS Covid-19 vaccination programme has started. When it is the right time, people will receive an invitation to come forward. For most people this will... Find out more

Important -

Staff and clinicians at the surgery are working under immense pressure during this pandemic. Like many businesses at the moment, we are working at reduced staffing capacity due to ... Find out more

Important -

A notice to remind patients that practices are open Monday to Friday 8am – 6:30pm and that it is only during these times that eConsult should be used.

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