Repeat Contraceptive Pill

Completing this form in full should enable us to issue your pill repeat (maximum 12 months supply) without you having to make an appointment. If we have any questions then a doctor or nurse will call you within 48 hours to clarify things. It is vital that all questions are completed as accurately as possible.

You will be able to get your blood pressure and weight checked at your local pharmacy or at the surgery reception (between 10am - 5pm only). We cannot issue your pill without these measurements.


Please email your completed form to

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