Contraceptive Pill Review

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

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 -

From 1 April, 2021, the Bermuda and Marlowe Practice will be renamed the Shakespeare Road Medical Practice. The change of name will not affect patients registered at Bermuda and... Find out more

Important -

With effect from the 22nd March, we are starting a new appointment system following an in-house evaluation, to give you the patient, the best medical care possible. The Reception ... Find out more

Important -

Your GP practice is being supported by the NHS North Hampshire Clinical Commissioning Group (CCG) to improve services for all patients. The Care Quality Commission (CQC) has recen... Find out more

Important -

Please note the practice is currently not accepting new patients. The practice can only register newborn babies, and newly fostered or adopted children of patients already registe... Find out more

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