Contraceptive Pill Review

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

Contraceptive Pill Review

Contraception Pill Review

Have you had any recent changes in your health that might affect your contraception? *
Have you ever had a blood clot in your legs or lungs (deep vein thrombosis or pulmonary embolus)? *
Do you have any blood clotting abnormalities? *
Do you have parents or siblings who have ever been diagnosed with a blood clot in their legs or the lungs (deep vein thrombosis or pulmonary embolus)? *
Do you have parents or siblings who have had heart disease or strokes under the age of 55? *
Do you have parents or siblings who have had breast cancer under the age of 50? *
Have you given birth within the last 6 weeks? *
Do you suffer from severe headaches or migraines? *
Are you experiencing any irregular vaginal bleeding? *
Do you currently smoke or have you stopped smoking in the last year? *

Blood Pressure

If you do not have a machine at home, please come to reception and have your blood pressure and weight measured on the practice machine.

This is needed for ‘combined pills’ or the  patch with oestrogen and progesterone.

It is not needed for progesterone only pills (mini pills) eg desogestrel/cerazette/noriday.

If your blood pressure is above 140/90 please book a telephone consultation with a GP for a review.

Calculate my BMI

Please note: BMI calculator is only for patients aged 18 and over.

Please visit NHS UK: BMI Calculator to calculate your BMI. Once your BMI has been calculated, please enter this in the box below. 

Would you like to consider longer acting forms of contraception that may not need you to remember to take your pill every day? *

You can visit the following website for more advice:


If you would like a contraceptive implant, intra uterine device or contraceptive injection, please contact Reception.

Please be aware that some medication can reduce the effectiveness of ‘the pill’ (combined oral contraceptive pill) so if taking new medication, always check with the pharmacist or prescriber (this includes St John’s wort which you should avoid).

Please take a look at the link below for general advice on the pill including different ways to take it (4 day break or tricycling) and what to do if you miss a pill.