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Contraceptives Consultation
You must fill in the following form before you can purchase your Contraceptives treatment
Contraception Consultation
What is your weight?
What is your height?
Are you currently using contraception today?
- Select -
Yes
No
Have you been reviewed by a healthcare professional for your contraception in the previous 12 months?
- Select -
Yes
No
Have you had a normal period (regular period) in the last 4 to 5 weeks?
- Select -
Yes
No
Are you or could you be pregnant from the previous 3 months?
- Select -
Yes
No
This could be due to factors such as:
- Having sexual intercourse without either a form of barrier contraception or any other form of contraception
- Having missed pills from an oral contraceptive
- Having been ill with vomiting and diarrhea will taking oral contraceptives
- Having changed your contraception
Do you smoke?
- Select -
Yes
No
Have you ever been diagnosed with migraines previously?
- Select -
Yes
No
Have you experienced any of the following symptoms?
- Select -
Yes
No
- Yourself or a member of your family have a history of blood clots
- You have had any major surgery in the last 2 months
- Any Vaginal bleeding when not on your period or any vaginal discharge
- You have been informed previously by a healthcare professional that Combined oral contraceptives are not suitable for you
What is your blood pressure?
- Select -
Low (below 90/60mmHg)
Normal (between 90/60 and 140/90)
High (above 140/90)
Have you checked or had your blood pressure checked in the previous 6 months (taking at least 3 readings)
- Select -
Yes
No
Have you been diagnosed with any other medication conditions?
- Select -
Yes
No
If so, please provide more information
Please provide more details
Do you suffer with any allergies?
- Select -
Yes
No
If so, please provide more information
Please provide more details
Are you currently taking any medication this includes prescription only medication, over the counter medication and any herbal remedies
- Select -
Yes
No
If so, please provide more information
Please provide more details
Are you pregnant, planning a pregnancy or breast-feeding at the moment?
- Select -
Yes
No
Is there any other information you would like to share with our team?
- Select -
Yes
No
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?
- Select -
Yes
No
I have read and understood the
Terms and Conditions
.
- Select -
Yes
No
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Acid Reflux
Acne
Chlamydia
Contraceptives
Cystitis (UTI)
Eczema
Emergency Contraception
Erectile Dysfunction
Hair Loss
Hair Removal
Hayfever
Heavy Periods
Herpes
IBS
Malaria Prevention
Migraine
Nail Infection
Period Delay
Period Pain
Premature Ejaculation
Psoriasis
Stop Smoking
Thrush
Weight Loss
Video Consultation
How it works
About us
Blog
Contact Us
