Contraceptive Pill Review

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

Please be aware, that if you submit a form outside of working hours, it will not be viewed until the next working day.

If you are human, leave this field blank.

About You

Height *

In Metres

Weight *

In KG

Contraception Pill Review

Do you regularly check your breasts?

Yes

Please ask reception for our information regarding the importance of regular breast self-examination.

Do you suffer from severe headaches or migraines?

Yes - But the Doctor is unaware

Yes - But the Doctor is aware

Please make an appointment to see your doctor to discuss your headaches if you have not already done so.

Are you experiencing any irregular bleeding?

Yes

Please book an appointment to see the practice nurse

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

Important -

Junior Doctors’ Strike – For more information about the expected disruption to NHS services across Surrey and advice on how to access urgent care please visit www.surreyheartl... Find out more

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On Thursday 13th April, the Practice will be having upgrade work completed on our computer systems. Between 12 noon and 2pm, access to our systems will be severely limited. While t... Find out more

Important -

From 31st March 2023 free GP video consultations via Livi will no longer be available for patients in North West (NW) Surrey – Elmbridge, Runnymede, Spelthorne and Woking. The... Find out more

Important -

Due to the recent increase in flu and COVID cases, we have been advised by NHS Surrey Heartlands to ask our patients to wear face coverings in all areas of the Practice. These... Find out more

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