Contraceptive Pill Review - Trent Meadows Medical Practice

This form should only be used for people currently prescribed either COCP or POP contraceptive pill.

Name

First Last

Date of Birth

Phone

Enter Email Confirm Email

Height

In Metres

Weight

In KG

Do you regularly check your breasts?

Yes Optional

No Optional

Please ask reception for our information regarding the importance of regular breast self-examination.

Do you suffer from severe headaches or migraines?

Yes – But the Doctor is unaware Optional

Yes – But the Doctor is aware Optional

No Optional

Please make an appointment to see your doctor to discuss your headaches if you have not already done so.

Are you experiencing any irregular bleeding?

Yes Optional

No Optional

Please book an appointment to see the practice nurse.

Total Triage - LIVE from the 3rd November 2025