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Contraceptive Pill Review

Your Details

DD/MM/YYYY
Find my NHS Number (opens in new window)
Your Contact Details

Review
Do you smoke?
Do you use an e-cigarette?
Do you suffer from migraines (with or without aura) or severe headaches?
Have you had a deep vein thrombosis or pulmonary embolus?
Do you have any blood clotting illness or abnormalities?
Have any of your immediate family (parents or siblings) been diagnosed with heart disease, stroke, deep vein thrombosis or pulmonary embolus under the age of 45, or have diabetes (at any age)?
Is there any family history of breast cancer under the age of 50?
Do you take St John’s Wort?
Do you know?
Do you know the best thing to do if you miss a pill dose?
Do you know that if you have been vomiting, suffering from diarrhoea or if you are on antibiotics that this impacts the effectiveness of the pill (i.e. it may not work).
Do you know that the contraceptive pill is to prevent pregnancy only, it will not prevent the transmission of sexually transmitted diseases or infections. To protect against these you should use a condom.

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This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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Paragon Practice

215 Kirkham Road, Freckleton, Lancashire, PR4 1HG

  • 01772 123456
© Neighbourhood Direct Ltd  2025
Website supplied by Oldroyd Publishing Group

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Local Services
Carers UK
Your Service
Here
Macmillan
Cancer Support