Progesterone Only Contraceptive Pill



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Please complete this form to request a repeat prescription of your progesterone only oral contraceptive pill e.g. Cerazette, Cerelle

  • For the combined oestrogen progesterone pill (e.g. Microgynon) please use the 'Combined oral contraceptive pill request form'
  • Information on the different contraceptive methods available in the UK
  • If you would like to have an implant or coil fitted or removed, please contact the LSL Contraception Clinic on 0345 300 2350 to book an appointment – lines are open Monday to Sunday 7am – 11pm. 
Personal Details
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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.


Please provide a blood pressure reading taken within the previous month (systolic/diastolic e.g. 125/75). You can get your blood pressure checked at a pharmacy or book an appointment with the healthcare assistant

Upper Reading

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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