Combined pill (generic) 3 months

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Have you ever been diagnosed with high blood pressure (hypertension)?

When was your blood pressure measured?

Who measured your blood pressure?

Please tell us the name of the clinic, GP surgery, hospital or pharmacy that measured your blood pressure.

Do you know your last blood pressure reading?

Did the healthcare professional confirm that your blood pressure was normal?

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How would you describe your gender identity?

How would you describe your gender?

Is your gender identity the same as the sex you were assigned at birth?

Which of these describes you best?

How would you describe your sexual orientation?

What is your height?

What is your weight?

What was your most recent blood pressure reading?

Have you taken the combined pill before?

Have you ordered the combined contraceptive pill from SH:24 before?

Ethinyloestradiol (30 micrograms) + levonergestrel (150 micrograms). You may know this as Microgynon, Rigevidon, Levest, Maxaeni or Ovranette

Ethinyloestradiol (35 micrograms) + norgestimate (250 micrograms). You may know this as Cilest, Lizinna or Cillique

Ethinyloestradiol (30 micrograms) + desogestrel (150 micrograms). You may know this as Marvelon or Gedarel 30

Ethinyloestradiol (20 micrograms) + desogestrel (150 micrograms). You may know this as Mercilon or Gedarel 20

Ethinyloestradiol (30 micrograms) + gestodene (0.075 milligrams). You may know this as Femodene, Millinette 30, Sofiperla or Katya

Which pill have you generally used?

Would you like to speak to a clinician about your options?

Has a nurse or doctor ever told you it is not safe for you to use some methods of hormonal contraception?

Can you tell us more about this?

What is your current method of contraception?

Have you had a baby in the last 6 weeks?

Did you have any complications during childbirth?

Are you breastfeeding or chestfeeding?

I currently smoke/vape/use tobacco products

I quit smoking/vaping/tobacco products within the last year

I quit smoking/vaping/tobacco products more than a year ago

I have never smoked/vaped/used tobacco products

Do you smoke, vape, use e-cigarettes or any other tobacco products including shisha pipes?

Do you have diabetes?

Do you have any complications with your diabetes e.g. eye problems or kidney problems?

What medication do you take for your diabetes? 

Do you have limited mobility?

Are you allergic to lactose?

I can tolerate the small amounts of lactose in pills

I can NOT take pills with small amounts of lactose

Can you tolerate small amounts of lactose?

Are you allergic to peanuts?

Are you allergic to soy?

I can take medication that contains soybean oil

I have a severe nut allergy and need to discuss alternative options

Do you need soy-free medication?

Are you allergic to oestrogens in combined hormonal contraceptives?

Are you allergic to progestogens in hormonal contraceptives?

Are you allergic to doxycycline?

Are you allergic to azithromycin?

Are you allergic to aciclovir?

Are you allergic to podophyllotoxin?

Are you allergic to imiquimod?

Are you allergic to any other medications or foods?

What are you allergic to?

Are you currently taking any medication or herbal remedies?

What medication or herbal remedies are you taking, and what conditions are you taking these for?

Have you been at risk of pregnancy in the last 3 months?

Please let us know if you have done a pregnancy test since your most recent pregnancy risk.

Yes, I have had my normal period or bleed

No, but this is normal for me (because of my contraception or another reason)

No, I have not had a bleed and this is not normal for me

Have you had a normal period or bleed in the last 6 weeks?

You have told us that you have not had a period in the last 6 weeks and that this is not normal for you. Please tell us more about this.

Please tell us more.

Have you ever had a blood clot (thrombosis)?

Do you have any conditions that affect your heart or circulation?

Has a close relative (mother, father, brother, sister) had a blood clot, stroke or heart attack under age 50?

Do you have a condition that affects your blood clotting?

Do any of these conditions run in your family?

Have you been told you have high cholesterol (hyperlipiademia)?

Have you had or do you have breast cancer?

Have you done a genetic test that showed genes associated with a higher risk of breast cancer (BRCA1, BRCA2, or others)?

Do you have discharge, nipple changes or a lump in your breast area and you do not know what's causing it?

Have you experienced any unusual vaginal bleeding in the last 2 years?

Can you please tell us more about your irregular bleeding and related symptoms?

Have you had a normal smear in the last 3 years?

Have you had a negative pregnancy test in the last 4 weeks?

Have you had a negative STI test in the last 4 weeks?

Have you ever been diagnosed with liver or gallbladder problems?

Please tell us more about your liver or gallbladder condition, including the diagnosis and any treatments you have had.

Have you been diagnosed with an autoimmune disease?

Please tell us about your autoimmune condition including the diagnosis and any treatments you have had.

Have you ever had gastro-intestinal (bowel) or gallbladder problems?

What gastro problems do you have?

Do you get headaches or migraines that last for 4 to 72 hours?

Do you experience any of the following when you get a headache?

Did these headaches start or get worse since starting a combined method of hormonal contraception (combined pill, contraceptive patch or vaginal ring)?

Have you ever had a loss of consciousness before a migraine headache or a loss of power in your legs during a migraine headache?

Include blank spots in your field of vision

Include zigzag lines in your field of vision

Affect the same area of vision (left or right) through both eyes

Do you ever experience changes to your vision (migraine aura) that:

Have you ever had any other health conditions, illnesses, major surgery or medical treatment that we should know about?

Does anyone in your life make you feel scared or unsafe?

Do you feel down or depressed?

Is your partner a lot older than you?

Has anyone given you something, like gifts or money, for sex?

Have you been pressured into sex?

Do you feel scared or uncomfortable with anyone you have sex with?

Have you been sexually assaulted?

Some communities practise female circumcision or cutting, where the female genitals are deliberately cut or changed. Has this happened to you?

Are there any girls or young women in your household whose cutting, closing or circumcision might be planned?