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Mini Pill
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Example Cerelle, Cerazette, desogestrel and Noriday
Mini Pill
Complete the eReview below for a repeat of your mini progesterone only pill. You will not need to attend the surgery. Please research mini progesterone only pill before advancing with this eReview.
First Name
*
Last Name
*
Email
*
Enter Email
Date of birth
*
Please use format day/month/year e.g. 12/05/1979
Mini Pill Review
Are you happy with your current Pill ?
*
Yes
No
What is your weight in kg eg 65 kg
*
How tall are you?
*
We need this to calculate your BMI
Do you smoke?
*
Yes
No
Do you understand and the risk and benefits of your current contraceptive?
*
Yes
No
Would you like to consider the coil or implant?
*
Yes
No
Best number to call you on
*
One of our clinicians will contact you on this number in the next couple of weeks.
Please add a comment about your contraception. The Practice will be in contact soon.
*
Privacy Policy
This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our
Privacy Policy
to discover how we protect and manage your submitted data.
*
I consent to the practice collecting and storing my data from this form.
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