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.
Any responses we send will go to this email address.

Current Contraception

Health Check

Please note – We will be unable to issue the medication without an up to date blood pressure reading. If you do not have access to a blood pressure monitor at home there is one available for use at the surgery.

Pregnancy

Sending