Contraceptive Pill Review

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

Once the form has been submitted, please check your emails regularly.

If you are human, leave this field blank.

About You

Height *

In Metres

Weight *

In KG

Contraception Pill Review

Do you regularly check your breasts?

Yes

Please ask reception for our information regarding the importance of regular breast self-examination.

Do you suffer from severe headaches or migraines?

Yes - But the Doctor is unaware

Yes - But the Doctor is aware

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?

Yes

Please book an appointment to see the practice nurse

I confirm that the information provided is accurate to the best of my knowledge

Important -

Junior Doctors’ Strike – For more information about the expected disruption to NHS services across Surrey and advice on how to access urgent care please visit www.surreyheartl... Find out more

Important -

Our local NHS system, NHS Surrey Heartlands, would like to share some information with our patients about how we, along with the other practices in the area are working to provide ... Find out more

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