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Online  Treatment

Family Planning Pill & Patch

Only €23 per Script

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Family Planning Pill & Patch

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If you are between 17 and 35, and wish to use "contraception scheme", please stop filling out this form and go to your GP only.
Are you using this medication currently?
Duration of using this medication?
Are your periods regular?
Are you experiencing any side effect on this medication?
Do you suffer with any irregular vaginal bleeding or discharge?
Are you pregnant? or planning to be pregnant? or breastfeeding?
Do you smoke?
Have you ever been diagnosed with blood clots, Liver Disease, Cancer, Diabetes, Migraine or severe headaches, Blood pressure or heart disease?
Have you ever got your Cervical Smear Test done?
Do you have any family history of stroke or brain haemorrhage or heart disease, Cancer or blood clot?
Do you have any past medical or surgical history that you want to mention to our doctor?
Are you allergic to any medication or any other substance?
I confirm that the answers I have provided for the above questions are true and accurate to the best of my knowledge.
I confirm and agree that any treatment prescribed for me is for my personal use only.
I fully understand the side-effects of the treatment options, their effectiveness and alternative options and am happy to continue with my request.
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