Contraceptive Pill Review

If you have been advised by the surgery to submit a contraceptive pill review please use this form.

If possible please check your own blood pressure at home using a blood pressure machine and pass these to the surgery so your pill review can then be done over the phone.

Contraceptive Pill Review

Contraceptive Pill Review

About You

In Metres

Blood Pressure Reading

For a list of validated home blood pressure monitors, visit or discuss with your pharmacy.

Please use 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