Please complete the form below to request a repeat prescription of your oral contraceptive pill. Please ensure you click ‘submit’ at the bottom of the page when you finish.
Please do not use this form if you are requesting to start or change your contraceptive or you are experiencing any side-effects or problems with contraception. Please book an appointment with a doctor.
You will need a recent (within last one month) blood pressure, height and weight. These can be done at many pharmacies if you cannot do them at home.
Please ensure you are up-to-date with your cervical smears.
Information on the different contraceptive methods available in the UK is available at www.sexwise.fpa.org.uk
Effective long-acting contraceptive methods such as the contraceptive implant and coils are available. Please book a telephone appointment with Dr Dhairyawan or Dr Heerah to discuss this further.
There is a section on the form which allows you to raise any personal concerns that you may have, such as mental health, social concerns, or domestic violence. Please have confidence in raising any concerns as we may be able to help.
Please allow FIVE WORKING DAYS for your request to be processed, you may be contacted by telephone or email, or asked to attend the surgery if we require further information.
Pill Check Questionnaire