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.

Contraception Pill Review

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

Lifestyle

Smoking Status:
Are you interested in Cessation advice?

Blood Pressure

You can submit blood pressure readings in various ways

  • An average of readings done on a home monitor, ideally from readings taken
    morning and evening for 1 week.
  • A reading taken on the monitor in the surgery of the waiting room
  • A reading taken by the health care assistant at the surgery

Latest blood pressure reading:

Please note that the details you give will be used to update your medical records.

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