Andover Health Centre Medical Practice > Services > Forms > Health Review Forms > The Combined Pill Review Form

The Combined Pill Review Form

The Combined Pill — e.g. Microgynon, Rigevidon, Ovranette, Yasmin

We can offer a telephone/video review  rather than having patients attend the surgery unnecessarily.  Below there are links to information

You will need an up to date blood pressure reading before you complete the online details. This can be easily organised using a home monitoring machine or through local pharmacies and Gyms. Please record this before you complete the application.

Different Contraceptive Choices

Combined pill including new ways to take it

Combined Pill
Enter Email
Please use format day/month/year e.g. 12/05/1979

Your Height and Weight

Weight

Unit of measurement *
cm
kg
ft
in
lbs

BMI

Underweight
Healthy
Overweight
Obese

Combined Pill Review

Are you happy with your current Pill ? *
e.g. 120/70
Do you smoke? *
Have you ever had a blood clot, heart disease, stroke, cancer, migraine or major illness? *
Do you understand and the risk and benefits of your current contraceptive? *
Have you read about or do you already take the pill continuously? *
Have you considered the coil or implant? *
One of our clinicians will contact you on this number in the next couple of weeks.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.
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