Contraceptive Pill or HRT information required

If you have been asked to submit your weight and BP for the Contraceptive Pill or HRT, please use this form

Last Updated: 13/04/2023

Your Details

Name

Date of Birth
For example, 15 3 1984

Day

Month

Year

Phone Number (optional)

Email Address

Weight

height

Blood Pressure (if you don't have a monitor you can use the health portal located in the waiting room) (optional)

SMOKER?

Yes

No

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