Contraceptive Pill - Repeat Prescription Request

This form is for the repeat prescription of the oral contraceptive pill.

We will process your request for a prescription in the next 5 working days. If you would like your prescription to be sent to a pharmacy, this will also need to be entered into the form, or inform the receptionist.

It is important to know what to do if you ever miss / forget to take one of your pills. NHS can talk you through what to do If you are ever in doubt please speak to a GP or pharmacist for advice the same day.

Remember that the contraceptive pills do NOT protect against sexually transmitted infections (STIs), using condoms in addition to your pill will reduce your risk of catching an STI.  See for more information

There are other long acting methods of contraception available, if you would like to discuss please book to see the practice nurse or see

Contraceptive Pill - Repeat Prescription Request
Questionnaire For Repeat Prescription Of The Oral Contraceptive Pill

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Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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