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Combined Contraceptive Pill Review

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Blood Pressure

If you are not able to find a way to measure your blood pressure, you can attend the surgery and use our surgery pod which is located in the reception area. You can also check your weight here.

If you are on a combined pill, a blood pressure and weight are required to ensure safe prescribing.

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Contraceptive Pill Review

This form collects your medical information. Please read our Privacy Policy to discover how we protect and manage your submitted data.

I consent to the practice collecting and storing my data from this form: *

Will you be over 35 years or older within the next 12 months?: *

Smoking Status: *

Have you or your immediate family ever been diagnosed with any of the following: *

Have you been diagnosed with/or experienced any of the following conditions in the past 12 months?: *

Are you currently taking any of the following medication? : *

Have you ever suffered from migraines, headaches or numbness to one side of your face/body?: *

Have you ever suffered from difficulty with your speech?: *

Would you like to discuss "what to do in the event of a missed pill with your practice nurse?: *

Would you like to discuss long acting reversible contraception options with your practice nurse?: *

Are you taking weight loss injectables? This can effect your contraception: *

Do you have enough medication to last 7 days?: *

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Further Information

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This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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Combined Contraceptive Pill Review

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