Pill Review Form

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Please complete your details below and you will be added to the waiting list and the practice will contact you when an appointment is available

This form can also be completed through our online services

For your safety, to be able to apply for a repeat prescription annually

  • You must have had your blood pressure and weight measured in the last year, please use a home BP machine or the self-monitoring machine in the waiting room.
  • You must have had a cervical smear test within the last three years if you are aged 25 or over.

If you would you like an STI test please contact the surgery to arrange one or call 01392 276892 (Sidwell street sexual health clinic).

Statements
So it is advisable to use condoms or get a STI screen with new partners

You have answered No to one or more of the questions above,

Please use the resources below to find out more information. If you are then still not confident enough to answer Yes to any of the questions above, please arrange an eConsult or telephone appointment

INFO ON RISKS, DRUG INTERACTIONS & SIDE EFFECTS

Contraception Pill Review

You have answered Yes to one or more of the monitored questions above, please arrange an eConsult or telephone appointment

Health Questions
Please indicate whether you have used feet, inches, metres or centimetres)
Please indicate whether you have used stones, pounds or kilogrammes
Personal Details
Please double check you've entered the correct email address
May be used to identify you

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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