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

In Metres

Breast Examination

Breast self-examination, or regularly examining your breasts on your own, can be an important way to find a breast cancer early, when it's more likely to be treated successfully.

Please visit for information regarding breast screening.

Contraception Pill Review

Are you happy with your current pill? *
Do you have any side effects? *
Are you experiencing any new headaches or serious headaches? If you are experiencing new, serious headaches or irregular bleeding you will need an appointment with a GP or nurse.

Please make an appointment to see your doctor to discuss your headaches if you have not already done so.

Have you had any bleeding that you weren't expecting; for example bleeding after sex or bleeding in the middle of a pill packet?

Please book an appointment to see the practice nurse

Blood Pressure

Please provide a blood pressure reading.

Home Blood Pressure Reading
Please upload any information relevant to your contraceptive pill review.
Maximum upload size: 67.11MB