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.
Blood Pressure
(Top Number)
(Bottom Number)
Providing a recent blood pressure reading is one of the most important parts of this review. If you do not have access to a blood pressure machine, you can usually get it checked at your local pharmacy.

Contraception Pill Review

Do you regularly check your breasts? *

Please visit the NHS Breast Aware website for more information on checking your breasts. www.nhs.uk/common-health-questions/womens-health/how-should-i-check-my-breasts

Do you get migraine with aura? *
Aura = Specific warning sign before the headache e.g. flashing lights.

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

What is your smoking status? *
Do you have acne? *

Calculate my BMI

e.g. 1.75
e.g. 60.6
Please note: BMI calculator is only for patients aged 18 and over.
BMI: Underweight
Find out what this means for you at NHS Choices.
BMI: Healthy Weight
Find out what this means for you at NHS Choices.
BMI: Overweight
Find out what this means for you at NHS Choices.
*
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