If you have been taking a contraceptive pill for over 12 months, you can order your annual prescription by completing the form below.
We encourage you to read the contraceptive information available at www.nhs.uk/conditions/contraception looking at the information on the Combined or Progestogen-only pill before completing the form.
It is essential to provide honest accurate information to allow our clinicians to make an informed decision on if it safe for you to continue with your chosen method of contraception. You may be asked to make a telephone appointment to speak with one of the nurses once you have submitted your form.
Please where possible submit the form to firstname.lastname@example.org alternatively post to the surgery.
Your prescription will take up to 4 working days to process and be dispatched to your chosen chemist upon receipt of the form.
Download a copy of the Contraceptive pill request form (for ages 16 year and over).