In order to provide the contraceptive pill safely we need to ask you a number of questions.

We would be grateful if you could complete and submit the below form.

Please note: without the completed form we will no longer be able to continue prescriptions of your contraceptive pill.

Please also note: To have your annual pill check completed a blood pressure measurement is required.

This can be done by contacting the surgery and booking an appointment to see our health care assistant, come into the surgery and use our self-monitoring machine or if you have a blood pressure monitor at home you can provide this reading instead.

If you have any problems with your medication or you would like to consider an alternative contraception options, please call us on 01798 342 248 to book an appointment with the Practice nurse.