This form will help us review your COPD, contraceptive pill & any other medications.
You will need an up to date weight and blood pressure.
Information on various contraceptive options can be found below:
This form also will ask you a number of questions about your COPD. It is important that this is done at least yearly to ensure we are keeping track of your symptoms.
Some medical conditions can mean hormonal contraception is not a safe option. Please answer the following questions below about your own health and family history.
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 and is accessed over a secure
connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to
Croft Medical Centre
Calder Walk, Leamington Spa, CV31 1SA.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.