Heavy Periods Consultation

You must fill in the following form before you can purchase your Heavy Periods treatment

Are you a female?

What is your D.O.B (dd/mm/yyyy)

Have you ever previously been diagnosed with heavy periods by a GP or any other healthcare professional?

Do your menstrual cycles follow a regular pattern each month?

Does your period currently regularly last more than 7 days?

Do you suffer with any of the following symptoms?

- Bleeding between periods - Irregular menstrual (period) bleeding (e.g. a very heavy month followed by a light month) - Passing large blood clots - Passing large amounts of blood during your period and feeling faint as a result during your period - Any other discharge from genital areas - Blood in the urine

Do you or your family have any history of endometriosis?

Have you recently suffered with any unexplained weight loss and/or a change in bowel habits?

Have you ever been informed that any form of contraception is not suitable for you?

Have you ever previously used any treatments for your heavy periods?

If so, please provide more information

Please provide more details

Is there any possibility you may have a sexually transmitted infection? (e.g. recent unprotected sexual intercourse with somebody who is not a long term partner)

Do you suffer with any allergies or allergies to any medications?

If so, please provide more information

Please provide more details

Are you currently taking any medications? This includes prescription only medication, over the counter medication and herbal medication

If so, please provide more information

Please provide more details

Are you pregnant, planning a pregnancy or breast-feeding at the moment?

Is there any other information you would like to share with our team?

If so, please provide more information

Please provide more details

We strongly recommend that you inform your GP of any treatment you receive. Would you like WePrescribe to do this on your behalf?

I have read and understood the Terms and Conditions.

Please see our terms and conditions here

Heavy Periods Consultation

Popular Treatments

Useful Links

Legal