Contraceptive Pill Review

Patients should only complete this form if advised to do so by a clinician.

Contraceptive Pill Review

Contraceptive Pill Review

About You

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In Metres
In KG

Contraception Pill Review

Do you regularly check your breasts?

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

Do you suffer from severe headaches or migraines?

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

Are you experiencing any irregular bleeding?

Please book an appointment to see the practice nurse

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