Contraceptive Pill Review Form

If your oral contraceptive review is due, or if you have been advised by the surgery to submit a contraceptive pill review please use this form.

A prescription for 1 month supply can be issued (if required) until your review is complete. By completing this form it may allow us to re-issue your pill without the need to an appointment, if it is safe to do so. 

If we need to speak to your before issuing any further prescriptions, we will contact you on the telephone number you have provided. 

If you don't hear anything from us after completing this form, a 6 month supply of your contraceptive pill will be sent to your nominated pharmacy for collection.

A blood pressure is required if you take the combined oral contarceptive pill. If you have a access to a blood pressure monitor at home, please record this. If this is not possible then please book an appointment with a nurse at the surgery (0345 189 7070, option 3) or at CTAC (Community Treatment + Care Hub 01224 550200) to arrange a blood pressure check, then fill out the form below. 

Last Updated: 24/11/2022

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