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 *

Phone Number

Email Address *

Weight *

height *

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

SMOKER? *

Yes No

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