Contraceptive Pill Review – No Break

Due to the current crisis we may take a little longer to deal with requests, we aim to deal with any queries as soon as possible, prescriptions and sick notes will be issued within 5 days and backdated where required.

Is this the right review form for you? Please note that there are separate forms for Asthma, COPD, the contraceptive pill and medication reviews. Please ensure that you complete the correct form.

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

Contraceptive Pill Review - No Break

About You

In Metres

Contraception Pill Review

Smoking Status *
Do you regularly check your breasts? *

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

Are you aware of the Missed Pill Rules? *
Do you take any over the counter medication that we may not be aware of? *