Contraceptive Pill Review

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
kg or stone & pounds
cm or feet & inches
Do you have diabetes?
Are you allergic to Oestrogen or Progesterone?
Are you taking prescription medications or the herbal medicine St Johns Wort?
Has anyone in your close family had a blood clot, stroke or heart attack under the age of 50?
Have you ever had blood clots, a stroke or mini stroke, heart disease (including heart attack) irregular heartbeat, high cholesterol problems or problems with your heart valves?
Do you have limited mobility (e.g. are you a wheelchair user)?
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