Medication
Review Form

Combined Oral Contraceptive Pill Review

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Combined Oral Contraceptive Pill
Review Form

Required fields are marked with an asterisk (*).

Please note:

  • Your blood pressure is required for this form
  • Forms submitted without a BP reading will not be actioned
  • You can visit your local community pharmacy to have your BP checked, use an at-home BP monitor or contact us for a BP check.
  • If you are aged 49+, please book a face-to-face appointment.

If you are looking to start a family, we would encourage you to start taking folic acid when you stop your pill.

PLEASE READ BEFORE PROCEEEDING

If you do not have a blood pressure reading, this form will not be processed.

Your Contact Details

GENERAL HEALTH CHECK
PILL-RELATED QUESTIONS
PERSONAL HISTORY
FAMILY HISTORY
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