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

Section

Blood Pressure Reading

If you are able to, please provide a home blood pressure reading.

Contraception Pill Review

Are you happy on your current pill?
Would you like to discuss switching to a different method of contraception?
e.g. 1.75
e.g. 60.6
Smoking Status:
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

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