Contraceptive Pill Review

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

Required field(s) are indicated by *
Contraceptive Pill Review

Contraceptive Pill Review

About you

As it appears on your passport.

As it appears on your passport.

The one used to register with your GP.

Your date of birth is required to verify your identity.

As on your medical record.
This phone number will be used for all correspondence relating to this request.

This email address will be used for all correspondence relating to this request. Please be aware that if you have given anyone else access to your email account they may see responses sent to you.

Please continue completing the form below

Blood Pressure

Please submit your most recent blood pressure reading.

For a list of validated home blood pressure monitors, visit www.bihsoc.org/bp-monitors or discuss with your pharmacy.

Contraception Pill Review

In Metres
In KG
Do you regularly check your breasts?
Do you suffer from severe headaches or migraines?
Are you experiencing any irregular bleeding?
*