Tell us whether you accept cookies

We've put some small files called cookies on your device to make our site work. We would also like to use analytical cookies to understand how our site is used and improve user experience. Analytical cookies send information to Google Analytics.

Let us know your preference. We will use a cookie to save your choice. Before you make your choice you can read more about our cookie policy.

Skip to main content

Staunton & Corse Surgery NHS GP Surgery in Gloucestershire

Contraceptive pill review

Contraceptive Pill Review

Section

Home Address (including postcode): *

It is important we have up to date measurements of your weight, height and blood pressure. Please supply us with measurements done within the last 2 weeks.

If you are a member of a gym or have your own equipment to use that is fine. Blood pressure monitors are available to purchase at pharmacies or online.

Height *

In Metres

Weight *

In KG

Blood Pressure

Systolic “Higher” *

Diastolic “Lower” *

Heart Rate

Contraception Pill Review

What contraceptive pill are you currently taking?

How often do you forget to take a pill? *

Do you think your pill is causing you side effects? *

Yes

No

Have you suffered from severe headaches or migraines since your last review? *

Yes

No

Have you or a close family member had a blood clot since your last review? *

Yes

No

Have you seen another doctor outside of this practice since your last review? *

Yes

No

Have you had any bleeding/spotting in between periods since your last review? *

Yes

No

Have you had any bleeding after sex since your last review? *

Yes

No

Are you aware of what to do if you miss a pill or have diarrhoea or vomiting? *

Yes

No

Have you had any abnormal discharge since your last review? *

Yes

No

Do you regularly check your breasts? *

Yes

No

Are you currently using a weight loss injection? *

Yes

No

Please specify:

Do you smoke? *

Yes

No

How many do you smoke per day? *

Confirmation *

I confirm that the information provided is accurate to the best of my knowledge

Confirmation *

I understand it may take a week for the pill review to be completed and that I will be contacted if further information is required

If you are human, leave this field blank.

Sending

Gloucester Road
Corse
Gloucester
Gloucestershire
GL19 3RB

Get directions

01452 840228

About the surgery

Register with the surgery

Sick (fit) notes

Feedback and complaints

© Silicon Practice

Accessibility statement

Website policies