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

In Metres

Blood Pressure

Contraception Pill Review

Smoking Status: *
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.

Do you have any side effects? *
Any history or family history of Venous Thromboembolisms (i.e. blood clots)? *
Are you experiencing any irregular bleeding or abnormal discharge? *
Do you regularly check your breasts? *