Requesting Repeat Progesterone-Only Contraceptive (Mini Pill)

Last Updated: 22/03/2024

  • Request Repeat Progesterone-Only Contraceptive

    • Please complete this form to request a repeat prescription of your progesterone-only contraceptive pill e.g. Cerelle, Noriday etc
    • A doctor might need to speak to you prior to issuing the prescription
    • Information on the different contraceptive methods available in the UK is available here
    • Information on having an implant or coil fitted or removed can be found here
    • Information on how to take your progesterone-only pill can be found here
    Date of Birth
    For example, 15 3 1984
    Name of Progesterone-Only Pill requested
  • Nominated Pharmacy

    Nominate a pharmacy of your choice and this pharmacy will receive your prescription directly from your GP, via the Electronic Prescription Service (EPS). With EPS you will not have to visit your practice to pick up your paper prescription anymore. (Click here for more details)

  • Health Details

    Use the link if you need help calculating the number of alcohol units you consume per week - Unit Calculator

    What is your smoking status?
    Have you ever had breast cancer, OR do you have any undiagnosed breast symptoms, OR are you known to have any breast gene mutation (e.g. BRCA1)?
    Have you ever been diagnosed with diabetes, high blood pressure, heart problems, stroke or high cholesterol?
    Have you ever been diagnosed with a liver or gallbladder problem?
    Do you have any problems with your mobility (e.g. wheelchair, debilitating illness)?
    Are you due to have any major surgery or have you had any major surgery in the previous 3 months?
    Have you had a baby in the previous 6 weeks?
    Are you taking any prescribed or over-the counter medication?
  • Declaration

    I confirm that this is a repeat prescription request
    I confirm that I am aware of how to take my pill
    I confirm that I am aware of different contraceptive methods and opt to use the progesterone-only contraceptive pill
    I confirm that any medication prescribed for me is for my personal use only and that I have responded honestly and provided complete and accurate information
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