If you have been advised by the surgery to submit a contraceptive pill review please use this form.
Contraceptive pills may cause serious complications in a few people.
These questions help us to identify those who may be at risk of complications therefore, it is essential for your own safety that you answer all of the questions accurately. It is your responsibility to ensure that the answers you give are honest and accurate.
In order to complete this questionnaire, you will require a blood pressure reading obtained within the last month. A blood pressure machine is available for you to use in the waiting room.