Consultation - Pharmaceutra

1 About Your Health

We ask about your general health, allergies, medical history, and medications to check if contraception is safe and suitable for you.

Are you a female?

Yes

Are you allergic to norethisterone or any other similar hormone medicines?

If yes, please detail them here, otherwise please type N/A

Women only: Are you pregnant or is there a possibility you may be pregnant?

Yes

Are you currently taking any other medicines including any herbal remedies? (e.g. St. John's Wort)

Have you ever been advised against using hormonal contraception by a healthcare provider?

Yes

2 About Your Condition

We ask about your contraceptive needs, past use, and any health factors to help match you with the most suitable option.

What type of contraception are you interested in?

What is your primary reason for seeking contraception?

Preventing pregnancy, managing menstrual cycle irregularities or if other please specify.

If you have chosen "Other (please specify)" for your reason for seeking contraception, please specify here.

Do you have a history of sexually transmitted infections or concerns about your sexual health?

Yes

Have you previously used any form of contraception?

Do you have a regular menstrual cycle?

Yes

Have you experienced any unusual symptoms, such as abnormal bleeding, severe abdominal pain, or unexplained weight changes?

Have you had a recent check-up with a healthcare provider regarding contraception?

Yes

3 The Agreement and Consent

Please read the Agreement and Consent statements carefully during your consultation. They contain important information to help you stay informed and safe throughout your treatment.

Do you agree to provide accurate and truthful information in this assessment?

Yes

Do you understand that the information provided will be reviewed to ensure the medication is safe and suitable for you?

Yes

Do you consent to the processing of your information for the purpose of this purchase, in compliance with data protection regulations?

Yes

Do you confirm that you will seek medical advice if your symptoms persist, worsen, or if you experience side effects from the medication?

Yes

Acid Reflux

Acne

Contraception

Eczema

Erectile Dysfunction

Hair Loss

HRT

Malaria Prevention

Premature Ejaculation

UTI

Weight Loss

Assessment for Contraception

Contraception

1 About Your Health

Are you a female?

Are you allergic to norethisterone or any other similar hormone medicines?

Yes

Women only: Are you pregnant or is there a possibility you may be pregnant?

Are you currently taking any other medicines including any herbal remedies? (e.g. St. John's Wort)

Yes

Have you ever been advised against using hormonal contraception by a healthcare provider?

2 About Your Condition

What type of contraception are you interested in?

What is your primary reason for seeking contraception?

If you have chosen "Other (please specify)" for your reason for seeking contraception, please specify here.

Do you have a history of sexually transmitted infections or concerns about your sexual health?

Have you previously used any form of contraception?

Yes

Do you have a regular menstrual cycle?

Have you experienced any unusual symptoms, such as abnormal bleeding, severe abdominal pain, or unexplained weight changes?

Yes

Have you had a recent check-up with a healthcare provider regarding contraception?

3 The Agreement and Consent

Do you agree to provide accurate and truthful information in this assessment?

Do you understand that the information provided will be reviewed to ensure the medication is safe and suitable for you?

Do you consent to the processing of your information for the purpose of this purchase, in compliance with data protection regulations?

Do you confirm that you will seek medical advice if your symptoms persist, worsen, or if you experience side effects from the medication?

Assessment Progress

Acid Reflux

Acne

Contraception

Eczema

Erectile Dysfunction

Hair Loss

HRT

Malaria Prevention

Premature Ejaculation

UTI

Weight Loss

Assessment for Contraception

Contraception

1 About Your Health

Are you a female?

Are you allergic to norethisterone or any other similar hormone medicines?

Yes

Women only: Are you pregnant or is there a possibility you may be pregnant?

Are you currently taking any other medicines including any herbal remedies? (e.g. St. John's Wort)

Yes

Have you ever been advised against using hormonal contraception by a healthcare provider?

2 About Your Condition

What type of contraception are you interested in?

What is your primary reason for seeking contraception?

If you have chosen "Other (please specify)" for your reason for seeking contraception, please specify here.

Do you have a history of sexually transmitted infections or concerns about your sexual health?

Have you previously used any form of contraception?

Yes

Do you have a regular menstrual cycle?

Have you experienced any unusual symptoms, such as abnormal bleeding, severe abdominal pain, or unexplained weight changes?

Yes

Have you had a recent check-up with a healthcare provider regarding contraception?

3 The Agreement and Consent

Do you agree to provide accurate and truthful information in this assessment?

Do you understand that the information provided will be reviewed to ensure the medication is safe and suitable for you?

Do you consent to the processing of your information for the purpose of this purchase, in compliance with data protection regulations?

Do you confirm that you will seek medical advice if your symptoms persist, worsen, or if you experience side effects from the medication?

Assessment Progress

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