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Contraceptive pill review

Contraceptive Pill Review

About You

eg. 1.75
eg. 60.6

Blood Pressure

Please provide a blood pressure reading if you have access to a machine.

For a list of validated home blood pressure monitors, visit www.bihsoc.org/bp-monitors or discuss with your pharmacy.

Please use date format: DD/MM/YYYY
/

Smoking

Smoking status: *

Smoker

What do you mainly smoke?
How many cigarettes do you smoke in a day? *
How many cigars do you smoke in a day? *
Would you like to give up smoking? *

If you would like help or advice to stop smoking, please visit NHS Quit Smoking.

Ex Smoker

What did you mainly smoke?
How many cigarettes did you smoke in a day? *
How many cigars did you smoke in a day? *

Contraception Pill Review

Do you regularly check your breasts?

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

Do you have normal periods (menstruation)? i.e. a regular cycle with no excessive or intermenstrual bleeding *
Please describe your cycle:

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

Do you know to take your your medication properly? *
Have you suffered from severe headaches or migraines in the past 3 months?

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

Confirmation