Important Update: Online Triage Moving to Accurx

We are upgrading our online triage system to Accurx to make it easier and faster for you to contact us. The new forms launch on 14 January 2026. Find out how this change benefits you and read our FAQs.

Contraception Review

Only complete the contraception review form if you have not completed one in the past 12 months.

Allow up to 5 working days for your completed review to be looked at.

If you require a prescription within 5 days contact your usual pharmacy for an emergency supply.

We aim to complete your request within 14 working days. Providing there are no issues with your answers, your prescription will be able to be collected from your usual pharmacy.

If we have any concerns, we will contact you.

If you will run out of your medication before 14 days please contact your pharmacy and ask for an emergency supply.

The practice opening hours are Monday to Friday, 8am to 6pm excluding public holidays.

If you are not on any contraception currently and would like to start. Please detail here which method you would like to consider and any issues you have had in the past with contraception.

Contraception Review
Please use format day/month/year e.g. 12/05/1979
Are you happy with it?
Any missed pills?
Get information on the contraceptive options available.
Please use format day/month/year e.g. 12/05/1979
Break Though Bleeding
Known Or Suspected Pregnancy
Please use format day/month/year e.g. 12/05/1979
Current History Or Past History Of Breast Cancer Or BRCA1 Gene In The Family
Breast Awareness: Regular Breast Check
Any Lumps, Changes In Skin, Nipples Or Surrounding Area Of Breasts
Focal Migraine (Severe Frequent Pulsating Pain In One Side Of The Head, With Nausea And Made Worse By Light, Noise Or Moving About)
Current Or Medically Treated For Gall Bladder Disease
Crohns Disease Or Ulcerated Colitis
Is there any Current Or Past History Or Family Member Under The Age Of 45 Of Deep Vein Thrombosis Or Pulmonary Embolus, Heart Disease, Stroke, TIA Or Arterial Disease
Uncontrolled Diabetes
Systemic Lupus Erythematosus
Any New / Recent Health Changes
Any Medication Recently Started Stopped, OTC Or Herbal Known Allergies
Home monitors are reliable, if you don’t have access to one, you could make an appointment to use our self check area.

Height and Weight

Weight

Please provide details of your heigh and weight in either Metric or Imperial units.
Unit of measurement *
Choose your preferred unit of measurement.
cm
kg
ft
in
lbs

BMI

Underweight
Healthy
Overweight
Obese
Smoking status
Your local pharmacy offers support to stop smoking.

Find out how to Quit Your Way.

This poses a greater risk to health than smoking tobacco alone. Please consider support to reduce your risks.

Would you like a sexual health check?
This is recommended if you are with a new partner or you believe you may have been exposed to a sexually transmitted infection.

Contact 03003030251 for sexual health clinic or make a telephone appointment with the Practice Nurse

Find out more about sexual health.

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.