Progesterone Only Pill Self Review

You will need a review of your progesterone only contraceptive pill (pop) before being issued with a further supply. This form is to ensure an uninterrupted supply of medication and avoid unnecessary visits to your doctor. This is your opportunity to flag any problems to us by answering a few short questions.

If you would like to continue on this method of contraception and do not feel that you need to see a clinician, please answer the questions below so that your prescription can be renewed if appropriate.

Personal Details
Date of Birth:
Have you had an operation in hospital? Can you remember when and what it was for?

Review Questions