Combined Contraceptive Pill/Patch Review

If you have been advised by the surgery to submit a Combined Contraceptive Pill/Patch Review please use this form.

Should you have been asked to submit a Mini-Pill/Progesterone-only Contraceptive Pill Review please visit this page.

Combined Contraceptive Pill/Patch Review

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.

Smoking Status

Please visit for information on services available to help with stopping smoking.

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

Please book an appointment to see the practice nurse

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