Contraceptive Pill Review

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

If you have any concerns about your contraception, please make an appointment with a GP or nurse.

Please Note – once you have submitted this information, any reply or acknowledgement from us will be sent to the email address you provide at top of the form. This response may include personal and sensitive information about you. We therefore strongly advise that you provide a personal email address that only you have access to. If you do not wish for us to communicate with you via email, please do not use this form and call us instead.

Contraceptive Pill Review/Pill Repeat Request

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
(in numerical digits e.g. '9' not 'nine')

Contraception Pill Review

Please ask reception about having this done.

Please make an appointment to see your doctor to discuss your headaches if you have not already done so.

Please ask reception for our information regarding the importance of regular breast self-examination.

We will contact you to discuss

If you would like more information please see or book to discuss these options with our pharmacist or a doctor.

Would you like a sexual health screen? Please see for further details.