Request for oral contraception

In order to renew your prescription for oral contraception, every year, we need to record BP, smoking status and height/weight. These can be provided by yourself at home and there is no need for an appointment at the practice. Please fill out the form below:

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Patient's Details
 
Values
You can provide BP readings taken at home. If you don't have a machine, you can buy one for £20, please click here for an approved list.
Please click this link to see info on how to take a BP reading properly (the key is to ensure you take it in a relaxed state)
Body Mass Index:

Please click here for information and help on how to give up

Medication request
Please ensure you provide the full name and the strength of the oral contraceptive you take. You can take a picture of the box or the previous prescription sheet and upload it below if that is easier:
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx

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.

 
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