Repeat contraceptive pill/patch/injection

This form is to be completed by patients OVER 16 already in receipt of a contraceptive prescription from the practice. For younger patients or those who are unable to complete the form themselves please contact reception and book an appointment with the nursing team.

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Personal Details
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In Metres
In Kilograms

Please allow 5 working days from submission of this form before a prescription is sent to the pharmacy.

Your answers will be reviewed by the practice nurse team and if necessary they will phone you to discuss any issues further.

If no issue(s) are raised they routinely send a SMS to your mobile to let you know that prescription has been sent to the chemist.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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