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    {"id":518,"date":"2026-07-21T19:32:31","date_gmt":"2026-07-21T18:32:31","guid":{"rendered":"https:\/\/surgerywebtemp.org.uk\/f81089\/?page_id=518"},"modified":"2026-07-21T19:32:31","modified_gmt":"2026-07-21T18:32:31","slug":"contraceptive-pill-review","status":"publish","type":"page","link":"https:\/\/surgerywebtemp.org.uk\/f81089\/contraceptive-pill-review\/","title":{"rendered":"Contraceptive Pill Review"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_16' ><div id='gf_16' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_16' id='gform_16'  action='\/f81089\/wp-json\/wp\/v2\/pages\/518#gf_16' data-formid='16' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_16' class='c-form-list gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_16_1\" class=\"gfield nhsuk-form-group gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='nhsuk-label gform-field-label' for='input_16_1'>Name&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_16_1' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_16_5\" class=\"gfield nhsuk-form-group gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Date of Birth&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div id='input_16_5' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_16_5_2_container'><label for='input_16_5_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Day<\/label><select class=\"nhsuk-select\" name='input_5[]' id='input_16_5_2'   aria-required='true'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_16_5_1_container'><label for='input_16_5_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Month<\/label><select class=\"nhsuk-select\" name='input_5[]' id='input_16_5_1'   aria-required='true'  ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_16_5_3_container'><label for='input_16_5_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Year<\/label><select class=\"nhsuk-select\" name='input_5[]' id='input_16_5_3'   aria-required='true'  ><option value=''>Year<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_16_3\" class=\"gfield nhsuk-form-group gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='nhsuk-label gform-field-label' for='input_16_3'>Phone&nbsp;&nbsp;<span class=\"nhsuk-tag\">Optional<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_16_3' type='text' value='' class='large nhsuk-input '      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_16_4\" class=\"gfield nhsuk-form-group gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='nhsuk-label gform-field-label' for='input_16_4'>Email&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_16_4' type='email' value='' class='large nhsuk-input '    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_16_6\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Will you be 35 years or older within the next 12 months?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_6' type='radio' value='Yes'  id='choice_16_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_6_0' id='label_16_6_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_6' type='radio' value='No'  id='choice_16_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_6_1' id='label_16_6_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/fieldset><div id=\"field_16_7\" class=\"gfield nhsuk-form-group gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='nhsuk-label gform-field-label' for='input_16_7'>Current Weight&nbsp;&nbsp;<span class=\"nhsuk-tag\">Optional<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_16_7' type='text' value='' class='large nhsuk-input '      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_16_8\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Smoking Status&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_8' type='radio' value='Smoker'  id='choice_16_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_8_0' id='label_16_8_0' class='gform-field-label gform-field-label--type-inline'>Smoker<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_8' type='radio' value='Ex smoker'  id='choice_16_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_8_1' id='label_16_8_1' class='gform-field-label gform-field-label--type-inline'>Ex smoker<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_8' type='radio' value='Never smoked'  id='choice_16_8_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_8_2' id='label_16_8_2' class='gform-field-label gform-field-label--type-inline'>Never smoked<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_9\" class=\"gfield nhsuk-form-group gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label nhsuk-label_before_complex' >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?&nbsp;&nbsp;<span class=\"nhsuk-tag\">Optional<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox nhsuk_checkbox ' id='input_16_9'><div class='gchoice nhsuk-checkboxes__item gchoice_16_9_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_9.1' type='checkbox'  value='Deep vein thrombosis (a blood clot in the veins of the leg)'  id='choice_16_9_1'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_9_1' id='label_16_9_1' class='gform-field-label gform-field-label--type-inline'>Deep vein thrombosis (a blood clot in the veins of the leg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_9_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_9.2' type='checkbox'  value='Pulmonary embolism (a blood clot in the lungs)'  id='choice_16_9_2'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_9_2' id='label_16_9_2' class='gform-field-label gform-field-label--type-inline'>Pulmonary embolism (a blood clot in the lungs)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_9_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_9.3' type='checkbox'  value='Stroke or cerebro-vascular disease'  id='choice_16_9_3'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_9_3' id='label_16_9_3' class='gform-field-label gform-field-label--type-inline'>Stroke or cerebro-vascular disease<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_9_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_9.4' type='checkbox'  value='Heart disease'  id='choice_16_9_4'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_9_4' id='label_16_9_4' class='gform-field-label gform-field-label--type-inline'>Heart disease<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_16_10\" class=\"gfield nhsuk-form-group gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label nhsuk-label_before_complex' >Have you been diagnosed with or experienced any of the following conditions in the past 12 months?&nbsp;&nbsp;<span class=\"nhsuk-tag\">Optional<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox nhsuk_checkbox ' id='input_16_10'><div class='gchoice nhsuk-checkboxes__item gchoice_16_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_10.1' type='checkbox'  value='Unexplained leg swelling'  id='choice_16_10_1'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_10_1' id='label_16_10_1' class='gform-field-label gform-field-label--type-inline'>Unexplained leg swelling<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_10.2' type='checkbox'  value='Chest pain that is worse when breathing deeply or unexplained shortness of breath'  id='choice_16_10_2'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_10_2' id='label_16_10_2' class='gform-field-label gform-field-label--type-inline'>Chest pain that is worse when breathing deeply or unexplained shortness of breath<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_10.3' type='checkbox'  value='High blood pressure'  id='choice_16_10_3'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_10_3' id='label_16_10_3' class='gform-field-label gform-field-label--type-inline'>High blood pressure<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_10_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_10.4' type='checkbox'  value='High cholesterol'  id='choice_16_10_4'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_10_4' id='label_16_10_4' class='gform-field-label gform-field-label--type-inline'>High cholesterol<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_10_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_10.5' type='checkbox'  value='Diabetes'  id='choice_16_10_5'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_10_5' id='label_16_10_5' class='gform-field-label gform-field-label--type-inline'>Diabetes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_10_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_10.6' type='checkbox'  value='Liver Disease'  id='choice_16_10_6'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_10_6' id='label_16_10_6' class='gform-field-label gform-field-label--type-inline'>Liver Disease<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_10_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_10.7' type='checkbox'  value='Gallbladder disease including gallstones'  id='choice_16_10_7'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_10_7' id='label_16_10_7' class='gform-field-label gform-field-label--type-inline'>Gallbladder disease including gallstones<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_10_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_10.8' type='checkbox'  value='Epilepsy'  id='choice_16_10_8'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_10_8' id='label_16_10_8' class='gform-field-label gform-field-label--type-inline'>Epilepsy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_10_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_10.9' type='checkbox'  value='Raynaud&#039;s disease'  id='choice_16_10_9'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_10_9' id='label_16_10_9' class='gform-field-label gform-field-label--type-inline'>Raynaud's disease<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_10_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_10.11' type='checkbox'  value='Breast cancer'  id='choice_16_10_11'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_10_11' id='label_16_10_11' class='gform-field-label gform-field-label--type-inline'>Breast cancer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_16_11\" class=\"gfield nhsuk-form-group gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label nhsuk-label_before_complex' >Are you currently taking any of the following medications?&nbsp;&nbsp;<span class=\"nhsuk-tag\">Optional<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox nhsuk_checkbox ' id='input_16_11'><div class='gchoice nhsuk-checkboxes__item gchoice_16_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_11.1' type='checkbox'  value='Anti-epileptic medication'  id='choice_16_11_1'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_11_1' id='label_16_11_1' class='gform-field-label gform-field-label--type-inline'>Anti-epileptic medication<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_11.2' type='checkbox'  value='Rifampacin'  id='choice_16_11_2'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_11_2' id='label_16_11_2' class='gform-field-label gform-field-label--type-inline'>Rifampacin<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_16_11_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_11.3' type='checkbox'  value='St Johns Wort'  id='choice_16_11_3'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_16_11_3' id='label_16_11_3' class='gform-field-label gform-field-label--type-inline'>St Johns Wort<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_16_12\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >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?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_12' type='radio' value='Yes'  id='choice_16_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_12_0' id='label_16_12_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_12' type='radio' value='No'  id='choice_16_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_12_1' id='label_16_12_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_13\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Have you suffered from any irregular vaginal bleeding, bleeding between periods or bleeding after sex in the past 12 months?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_13' type='radio' value='Yes'  id='choice_16_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_13_0' id='label_16_13_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_13' type='radio' value='No'  id='choice_16_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_13_1' id='label_16_13_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_14\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Have you forgotten to take your pill on more than one occasion per month?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_14' type='radio' value='Yes'  id='choice_16_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_14_0' id='label_16_14_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_14' type='radio' value='No'  id='choice_16_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_14_1' id='label_16_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_15\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Would you like to discuss &#039;what to do in the event of a missed pill&#039; with you GP or practice nurse?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_15' type='radio' value='Yes'  id='choice_16_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_15_0' id='label_16_15_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_15' type='radio' value='No'  id='choice_16_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_15_1' id='label_16_15_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_16\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Would you like to discuss long acting reversible contraception options with you GP or practice nurse?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_16' type='radio' value='Yes'  id='choice_16_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_16_0' id='label_16_16_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_16' type='radio' value='No'  id='choice_16_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_16_1' id='label_16_16_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/fieldset><\/div><\/div>\n        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