Medication
Review Form

Combined Oral Contraceptive Pill Review

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Combined Oral Contraceptive Pill
Review Form

Required fields are marked with an asterisk (*).

Please note:

  • Your blood pressure is required for this form
  • Forms submitted without a BP reading will not be actioned
  • You can visit your local community pharmacy to have your BP checked, use an at-home BP monitor or contact us for a BP check.
  • If you are aged 49+, please book a face-to-face appointment.

If you are looking to start a family, we would encourage you to start taking folic acid when you stop your pill.

PLEASE READ BEFORE PROCEEEDING

If you do not have a blood pressure reading, this form will not be processed.

Your Contact Details

GENERAL HEALTH CHECK
PILL-RELATED QUESTIONS
PERSONAL HISTORY
FAMILY HISTORY
Privacy Consent – This form collects personal and medical information about you/ We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage submitted data.

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Contraception Review Resources

Contraceptive Reviews
Information, help and guidance in relation to Contraception
Progesterone Only Pill Review
Complete the review form for Progesterone Only Pill
Contraceptive Coils
Information about contraceptive coils
Contraceptive Implants
Information about contraceptive implants

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03300 536456
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Update - Please note the practice will be closed from 6.30pm on Friday 1st May until 8.00am on Tuesday 5th May due to the Bank Holiday.

Think which service? - NHS Shropshire, Telford and Wrekin (shropshiretelfordandwrekin.nhs.uk) Please dial 111 for any non-urgent medical issue that cannot wait until the practice reopens. As always please only dial 999 for any urgent/life threatening matters.

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