MiniPill Review "*" indicates required fields Please read and complete this form to continue your prescription for the Minipill. The Minipill is also known as the progesterone only pill (POP) and types include Desogesterol, Cerelle, Cerazette and Noriday Information regarding the benefits and risks of this pill can be found hereName* First Last Date of birth* DD slash MM slash YYYY Mobile number if we need to get in touch*Usual GP* eg Dr Turnbull / Dr Brooks Please confirm that you have read and considered the above information about the Minipill* Yes No Do you have a history of breast cancer, blood clots, stroke or heart attacks?* Yes - THE PRACTICE WILL CONTACT YOU No Have you considered long acting contraception such as the coil, implant or injection?* I am not interested in long acting contraception I WOULD LIKE CONTACTED BY THE PRACTICE FOR INFORMATION ON THIS Are you happy with your Minipill?* Yes, please CONTINUE my medication for the next year No, I would like to DISCUSS this with a clinician Comments Optional CAPTCHA OptionalName OptionalThis field is for validation purposes and should be left unchanged.
