Oral Contraception Review

Please complete the following questions to allow your health care professional to assess your current contraception. This questionnaire is for a routine review of your use of contraception.

If you are experiencing any of the following ring your GP immediately:

  • Unusual or severe headaches
  • A faint or collapse
  • Migraines that are worse than normal
  • Painful swelling of your leg
  • Weakness or numbness of an arm or leg
  • Sudden problems with your speech or sight
  • Difficulty breathing
  • Coughing up blood
  • A bad pain in your tummy (abdomen)
  • Pains in your chest, especially if it hurts to breathe in
Oral Contraception Review

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.

Your Contraception

eg. Deep Vein Thrombosis or Pulmonary Embolism
Please select any that apply

Your Lifestyle - Alcohol

This is one unit of alcohol:

And each one of these, is more than one unit: