Oral Contraception

- tell us about your condition

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Intro

Medical

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What would you like help with today?

Which type of contraceptive pill are you interested in?

If you already have a preferred pill, please select it below.

If you selected Other, please tell us which contraceptive pill you currently use or would like to discuss.

Why have you chosen this option today?

Is there any possibility that you could be pregnant today?

Yes

Are you currently pregnant?

Are you currently breastfeeding?

Yes

How old is your baby?

Since your last menstrual period, have you had sex without reliable contraception?

If Yes, approximately when did this happen?

Have you used emergency contraception during your current menstrual cycle?

If Yes, please tell us which emergency contraception you used and approximately when you used it.

Have you taken a pregnancy test within the last four weeks?

What is your height?

Allowed values range from 40kg to 250kg

Allowed values range from 6st 4lbs to 39st 6lbs

Switch to st, lb

What is your current weight?

Allowed values range from 40kg to 250kg

Allowed values range from 6st 4lbs to 39st 6lbs

Switch to st, lb

What is your most recent blood pressure reading?

I know my blood pressure

I do not know my blood pressure

Do you currently use any nicotine products?

If you currently smoke cigarettes, approximately how many do you smoke each day?

Have you ever been diagnosed with migraine?

Have you ever been told that you experience migraine with aura?

Have you ever been diagnosed with any of the following medical conditions?

Have you ever been told you have complications affecting your eyes, kidneys, nerves or blood vessels?

You selected Blood clot — please tell us approximately when this happened and any treatment you received.

You selected Breast cancer — are you currently receiving treatment?

Yes

Do you have any close family members who have experienced a blood clot before the age of 50?

Have you ever been advised by a doctor, nurse or pharmacist not to take a particular contraceptive pill?

Yes

Please tell us which pill you were advised not to take and why.

Are you currently using any contraception?

You selected a contraceptive pill — which one do you currently use?

Approximately how long have you been using your current contraception?

Overall, how would you describe your experience with your current contraception?

You selected unhappy with your current contraception — what is the main reason?

Have you experienced any side effects from your current contraception?

Yes

Please describe the side effects you have experienced.

ave you ever stopped taking a contraceptive pill because of side effects or medical advice?

Yes

Please tell us which pill you stopped and why.

Is there anything else about your experience with contraception that you think your prescriber should know?

Do you currently take any prescription medicines?

Yes

Please list all prescription medicines you currently take, including the strength if you know it.

Have you started, stopped or changed any prescription medicines within the last three months?

Yes

Please tell us which medicines have changed and how.

Do you regularly take any medicines that you buy without a prescription?

Yes

Please list them below.

Do you take any herbal remedies, vitamins or food supplements?

Yes

Please list them below.

Do you have any allergies or have you ever had a bad reaction to a medicine?

Yes

Please tell us more about your allergies or reactions.

Are you currently under the care of a hospital specialist or waiting for any hospital investigations or treatment?

Yes

Please tell us more about your hospital care or investigations.

Are you expecting to have an operation or a period of reduced mobility during the next three months?

Yes

Please tell us more about your upcoming operation or reduced mobility.

Is all the information you have provided true and accurate to the best of your knowledge?

Yes

If your prescriber needs any further information, are you happy to be contacted securely through your PharmaBee patient portal?

Yes

Do you understand that completing this assessment does not guarantee that a prescription will be issued?

Yes

With your consent, we would like to inform your GP about any contraceptive medicine prescribed through PharmaBee.

Is there anything else you think your prescriber should know before making a decision about your treatment?

Yes

Please tell us below.

Please complete all required questions.