Online Pill Check

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About this form

If you take any of the oral contraceptive pills you will need an annual review (‘pill check’) at least every twelve months before we can re-authorise your prescription.

You may be due a review sooner if you have recently started or changed your pill.

This form will allow you to complete the pill check online. We have set up the online pill check with the aim of making it quicker and easier for you to renew your prescription if your pill is suiting you and you wish to continue it. If you are having any problems or concerns, or would like to discuss some of the newer ways of taking the combined pill, or discuss other forms of contraception, we would be more than happy to hear from you. Please book an appointment with your named GP or the practice nurse if you would like to discuss anything further.

To fill in this form you will need your current height, weight and blood pressure. If you do not have the equipment to measure these at home you are welcome to drop into the practice to do so (no appointment needed).

The pill check will be sent to the practice team and your request will usually be processed within 4 business days. If there are any issues we will contact you to discuss further. If there are no issues we will not contact you, and you may collect your pill from your nominated pharmacy.

If you need help navigating the form, please call the practice.

This form was last reviewed in January 2023.

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Your Details

Please double check you've entered the correct email address

We may use this to identify you.

It is important we check your blood pressure and weight while you are taking the pill.

Please take these measurements at the practice Reception or at home.

Please enter your blood pressure in the XX/XX format.

Preferred pharmacy to pick up this pill prescription: *

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Your Pill Check

Are you experiencing any problems with bleeding after sex or bleeding between periods?: *

Are you on any other medication in addition to your pill?: *

Have you been diagnosed with any new health conditions since we last issued you a prescription?: *

Do you smoke?: *

Do you suffer from migraine headaches? (Visual aura without headache also counts as 'migraine' in this context): *

Did your migraine headaches start since you started taking the pill?: *

Do you get an aura before your migraine headache starts?: *

Aura is when there are specific warning signs just before the migraine begins, for example a change in your vision. See The Migraine Trust information for clarification. If you are uncertain please contact the practice nurse or your named GP to discuss. It is vital you do not take combined oral contraception if you have migraine with aura, as this is known to increase your risk of stroke.: *

Have you ever had a blood clot (eg in your leg or in your lung, often referred to as a DVT or a PE)?: *

Has a close family relative (parent or sibling) ever had a blood clot?: *

Have you ever had breast cancer?: *

Has a close family relative (parent or sibling) ever had breast cancer?: *

Smear tests are an essential tool to prevent cervical cancer. They are offered to everyone with a cervix between the age of 25 and 64. The screening interval is every three years for those aged 25 to 49, and every five years for those aged 50 to 64. You will have received an invitation to book from the national screening service if you are due. Are you up to date with your cervical screening?: *

If you have received this invitation, or if you believe you are due a smear after reading the above information, please do book a smear test appointment with our nurse.

You should be aware of other, more reliable long-acting methods of contraception, such as the Coil and the Implant. These can last from 3 to 5 years and are more effective than any pill taken by mouth. We can fit any of these at Bridge Street - please see our Contraception page for more information and book a phone appointment with our nurse or your named GP to discuss further if you are interested.: *

You should be aware that no contraceptive pill is protective against sexually-transmitted infections. You can collect a self-swab to check for chlamydia from our reception at any time (no appointment needed), just ask for a ‘quick check test.': *

If you miss a pill, you may be at risk of an unplanned pregnancy. The rules for missed pills vary for the different types of pills. Please see our Sexual Health page for more information.: *

Your health and safety are important to us and we need to ensure that we have sufficient information to complete this review. If at any time you have concerns about your pill then please book a nurse or GP appointment.: *

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This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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Online Pill Check

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