Oral Contraceptive Pill Review Form
Please complete this form two weeks before you are due for your contraceptive pill review. If you have no problems with your contraceptive pill it may not be necessary for you to see the doctor and instead you may just complete this form fully and return it to us. We do need to know your height, weight and blood pressure. You can check these using home devices or use our health pod behind reception at Rosebery Medical Centre. It will only take five minutes.
Once we have processed the information on this form we will decide whether you can pick up a prescription for a further 12 month supply of pills, or whether the doctor wishes to see you – in which case we will contact you. It is helpful to have a mobile or home phone number on which you are happy for us to leave a message.
If you would rather see the doctor for your annual review, please make an appointment and bring the completed form to the appointment with you.
Please email your completed from to email@example.com
Important Note - Due to the current coronavirus outbreak our health pod at Rosebery Medical Centre is closed. If you are able to complete your blood pressure on a home device that would be very helpful but please submit the form without your blood pressure reading if you are unable to do this. Thank you.
Oral Contraceptive Pill Review Form v2.0 (Document, 52 Kb)