Contraceptive Pill Review

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

Please be aware that any replies from the surgery may appear in your junk or spam inbox.

There are many types of contraception available and none are perfect. The Contraception Choices website provides honest information to help weigh up the pros and cons.

Contraceptive Pill Review

Contraceptive Pill Review


Is this your up to date telephone number? *

Contraception Pill Review

In Metres
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

Blood Pressure

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

Please use this date format: DD/MM/YYYY.