Contraceptive Pill Review

If you have been advised by the surgery to submit a contraceptive pill review please fill-in this form and then use the automated machine at the surgery for BP/weight.

Contraceptive Pill Review

Contraceptive Pill Review

You must be between the ages of 18-50 with a BMI below 30 to use this form - If not please book an appointment with reception.

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
please give in cm
please give in kg
If you smoke, we strongly advise that you stop. If you would like help with this, please complete our self-referral smoking cessation form.
(1 unit = small glass of wine or half pint beer)

Contraceptive Pill Review

If over 25, have you had a smear test in the last 3 years? If not please book in at reception to have this done.
If you would like more information, please see www.fpa.org.uk or book to discuss these options with a family planning nurses/doctor.

Would you like a sexual health screen? Please see Royal Berkshire Sexual Health for further details.

Informed Consent:

Sending