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)
If you do not have access to a blood pressure machine, you can usually get it checked at your local chemist.

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 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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