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 -

The public are being reminded by NHS England that everyone accessing or visiting healthcare settings must continue to wear a face covering and follow social distancing rules. Covi... Find out more

Important -

From today (Monday 19 April), both urgent and non-urgent services at Shakespeare Medical Practice are running as usual. If you need to make an appointment or discuss a prescript... Find out more

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