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
In KG

Contraception Pill Review

Smoking Status: *

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? *