Contraceptive Pill Review

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

Please read the Contraceptive Pill Review Information page before completing this form.

Advice about long acting reversible contraception

Contraceptive Pill Review

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.

Your Blood Pressure


If you would like help in quitting, please visit SmokeFree Hampshire is a free NHS sevice helping poeple who want to stop smoking.

Contraception Pill Review

To order a STI testing kit online please visit

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.

Please book an appointment to see the practice nurse

Please note that the details you give will be used to update your medical records.