Contraceptive Pill Review

Date of Birth  Required
Will you be 35 years or older within the next 12 months?  Required
Smoking Status  Required
Have you, or any of your immediate family (mum, dad, brothers or sisters) been diagnosed with any of the following conditions within the past 12 months?  Optional
Have you been diagnosed with or experienced any of the following conditions in the past 12 months?  Optional
Are you currently taking any of the following medications?  Optional
Do you suffer from migraines with aura, or a headache associated with weakness or numbness on one side of your face or body, or difficulty with speech?  Required
Have you suffered from any irregular vaginal bleeding, bleeding between periods or bleeding after sex in the past 12 months?  Required
Have you forgotten to take your pill on more than one occasion per month?  Required
Would you like to discuss 'what to do in the event of a missed pill' with you GP or practice nurse?  Required
Would you like to discuss long acting reversible contraception options with you GP or practice nurse?  Required

Additional Information

Access to Medical Records

Blood Testing

Hospital Letters

Patient Charter

Practice Policies

Self-Referral

Submit a Clinical Review

Summary Care Record

Travel Advice