Contraceptive Pill Review



This online form is current in development and is only to be completed if you are asked to do so by the practice.  


At present this form is in a testing phase and only to be completed if we ask you to do so - it is for an annual review of the progesterone only pill (known as POP or mini pill). 

Common brands include (Aizea, Cerazette, Cerelle, Desogestrel, Desomono, Desorex, Drosiprenone, Feanolla, Moonia, Norethisterone, Noriday, Primolut, Zelleta but there are many others. If you are not sure what type of pill you are taking please arrange your review with the practice nurse as usual.

Page {{ paginatorProps.current }} of {{ }} ({{ paginatorProps.percentage }}% completed)
Personal Details

If you have been advised by the surgery to submit a contraceptive pill review please use this form.

Please double check you've entered the correct email address
May be used to identify you
Contraception Pill Review

For various reasons people will sometimes miss medications.  There is specific advice when it comes to the mini-pill on what to do and that advice varies between the types of pill you take.  Please see the following link to understand what counts as a missed pill and what the advice is for the specific pill you have taken.  If you havent followed this advice please do not complete this form and contact the practice to discuss what to do next.  What should I do if I miss a pill (progestogen-only pill)? - NHS (

Please make an appointment to see the practice nurse for review to make sure any changes to your health do not impact the contraceptive pill.

Sometimes new medication can affect the contraceptive pill.  It is likely this will already have been considered but please do not complete this form and contact the practice to arrange a pill review with the practice nurse.

Please follow the link to learn about how to self examine and what to look for - if you notice any new findings or are concerned, please book an appointment through reception with one of the practice doctors).  How should I check my breasts? - NHS (

Please book an appointment to see the practice nurse

Please contact the surgery to arrange a smear test with the nurse if you are overdue.

Privacy Consent

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.


There appears to be a problem loading the form, please refresh the page.
If the error persists please contact us.