Contraceptive Pill or HRT information required

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

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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Page last reviewed: 13 April 2023
Page created: 14 April 2023