Contraceptive Pill Repeat Prescription

Complete our form to request a repeat prescription of your oral contraceptive pill:

  • Your practice will aim to respond to your query within 2 working days.
  • If your query is not submitted, no details will be sent to your GP.
  • You must be over 16 to use this service, although you may use this service to contact the practice about a person you care for who is under 16.
  • You must be registered as a patient with Manchester Medical or a resident in, and am currently in, the UK.
Contraceptive Pill Repeat Prescription

This form is for non-urgent queries. Please only complete this form if you have had a blood pressure check within the last 6 months and can tell us the result. You can contact your pharmacist to arrange a blood pressure check if you have not had one done, and submit this form when you have the result.

Section

Are you currently taking the oral contraceptive pill, prescribed by a GP in the UK? *

This form is only for patients who are already taking the oral contraceptive pill and want a repeat prescription. 

If you want to start taking the contraceptive pill, please make an appointment with your GP or find a local family planning clinic through the Family Planning Association website. 

Is there any chance you could be pregnant, or have you had unprotected sex in the last 4 weeks (e.g. not using condoms when you have missed a pill)? *

It may not be appropriate for you to continue taking the COC. Please do not submit this form but contact your GP or Family Planning Clinic to discuss instead.

Was your blood pressure below 140/90 within the last 6 months? *

Raised blood pressure can make it unsafe for you to take the oral contraceptive pill. Please do not submit this form but contact your GP or Family Planning Clinic to discuss instead.

Blood Pressure

Please enter your blood pressure reading:

Smoking Status

Which of the following applies to you?

The combined oral contraceptive pill is not suitable for all smokers. For instance, women over 35 who smoke or have stopped smoking within the last year should not take the combined oral contraceptive pill because it increases the risk of complications.

Please continue to submit this form. Your GP will let you know if they can issue a prescription.

Please read our patient information leaflet on the combined oral contraceptive pill for more information.

If you are not sure if you are taking a combined oral contraceptive (COC) pill or a progesterone only pill, please check your packet and then select the correct option.

COC Pill 

The COC pill contains two ingredients, oestrogen and progesterone. Common brands include Microgynon, Rigevidon, Marvelon, Mercilon, Cilest, Ovranette, Yasmin, Femodene, Loestrin, Brevinor, Norimin.

Most COCs are taken for 3 weeks out of 4, with a 1 week gap. You will have been advised that you do not need to use another method of contraception as long as you have not missed a pill by more than 1 day.

Progesterone Pill

The progesterone only pill is taken at the same time every day, without a week off. Common brands include Cerazette, Micronor, Norgeston, Noriday, Cerelle.

You will have been advised that you need to use another method of contraception if you miss a pill by more than 3 hours (or more than 12 hours if you are taking a desogesterol pill).

Are you currently taking: *

Progesterone Pill

Do any of the following apply to you?

It may not be appropriate for you to continue taking Progesterone. Please do not submit this form but contact your GP or Family Planning Clinic to discuss instead.

Combined Oral Contraceptive Pill (Oestrogen and Progesterone)

Do any of the following apply to you?

It may not be appropriate for you to continue taking the COC pill. Please do not submit this form but contact your GP or Family Planning Clinic to discuss instead.

Suffering from migraines can increase your risk of serious complications from the COC. If your doctor knows about your migraines and has advised you that it is safe to take the COC, please submit this form.

However, if your migraines become worse or you develop symptoms of aura along with your headach (e.g. flashing lights before the headache) please contact your GP to advise them of this.

This service is intended for electronic communication between you and your Practice. The information may be read by any member of the Practice team and responded to by the most appropriate member of the team. Your Practice will endeavour to respond within the timeframe set for this form but will not be able to respond to urgent requests through this service.

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