Online Oral Contraceptive Pill Check | The Caversham Group Practice

If you would like to request a repeat prescription of the contraceptive pill you are currently taking and you are due a review of this medicine then please fill out the form below.

When you are taking the oral contraceptive pill you need to have a review (including blood pressure and weight) at least every 12 months. You may be due a review sooner if you have recently started or changed your contraceptive pill.

The information will be sent to the practice team and your request will be processed within 48 hours. In order to track the progress of your request please login via Patient Access.

First Name *

Surname *

Date of Birth *

Contact Phone Number *

Email Address

What is the name of your contraceptive pill? *

Please confirm that you have no new concerns about this pill (if you have new concerns/questions please book an appointment to discuss further). *

Confirmed

Have you started any new medication since we last issued you a prescription for the pill? *

Yes

If yes what is the name of this medicine? *

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

Yes

Please give further information *

Do you smoke? *

Yes

Do you suffer from migraines with aura (aura is when there are specific warning signs just before the migraine begins, for example visual disturbance) ? *

Yes

Have you ever had a blood clot? *

Yes

Have any of your relatives ever had a blood clot? *

Yes

Have you ever had breast cancer? *

Yes

Has anyone in your family had breast cancer? *

Yes

I confirm that I understand what to do if I miss a pill *

Confirmed

Information about what to do if you miss a pill can be found here.

It is important we check your blood pressure and weight while you are taking the pill. Please take the measurements below at the practice reception, in your local pharmacy or at home.

Weight in kg *

Height in cm *

Blood Pressure *

/ *

If you would like to read more about this and other contraceptive options please visit the Family Planning Association website and visit our practice contraception page.

If at any time you have concerns about your medication then please book a nurse or GP appointment.

I confirm that the information provided is accurate to the best of my knowledge *

Confirmed