Contraceptive Pill Review

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

If you are human, leave this field blank.

About You

Full Name: *

Phone Number:

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 -

We regret that we are unable to accept any new patients at the current time. Our commissioner, NHS Hampshire, Southampton and Isle of Wight Clinical Commissioning Group, has agree... Find out more

Important -

Due to unforeseen circumstances the surgery is experiencing low clinical staffing levels that will affect us throughout the summer, this means we have less available appointments a... Find out more

Important -

Dear patient, you are still required to wear a mask when attending the Practice for the safety of other patients and our staff. Please can we ask that if you are attending the Prac... Find out more

Important -

We are very sorry but we are currently unable to accept or register new patients apart from new babies born to existing patients. A temporary suspension has been being introduce... Find out more

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