Consultation | Crosshills Delivery Pharmacy

Contraception

This consultation ensures that the contraception you are purchasing is safe, effective, and suitable for your individual health needs. By answering the following questions, you provide essential information to assess your eligibility for the medication. The process is quick, confidential, and designed to help you make an informed decision about your contraceptive options.

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.

Question 1:Are you allergic to norethisterone or any other similar hormone medicines?

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

Question 2:Women only: Are you pregnant or is there a possibility you may be pregnant?

Yes

Question 3:Are you currently taking any other medicines including any herbal remedies? (e.g. St. John's Wort)

Question 4:Have you ever been advised against using hormonal contraception by a healthcare provider?

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.

Question 1:What type of contraception are you interested in?

Question 2:What is your primary reason for seeking contraception?

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

Question 3:If you have chosen "Other (please specify)" for your reason for seeking contraception, please specify here.

Question 4:Do you have a history of sexually transmitted infections or concerns about your sexual health?

Question 5:Have you previously used any form of contraception?

Question 6:Do you have a regular menstrual cycle?

Question 7:Have you experienced any unusual symptoms, such as abnormal bleeding, severe abdominal pain, or unexplained weight changes?

Question 8:Have you had a recent check-up with a healthcare provider regarding contraception?

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.

Question 1:Understanding of Risks

I have been informed about the potential side effects and interactions of the prescribed medication for Contraception.

Question 2:Medical Guidance

I agree to consult with my healthcare provider before starting any new medication.

I understand that the information provided in this assessment will be reviewed by a licensed pharmacist before my order is processed.

Question 3:Consent to Share Information

I consent to my personal and medical information being used to assess my suitability for the prescribed medication.

I understand that my information will be kept confidential and used solely for the purpose of this assessment.

Question 4:Confirmation

I confirm that the information provided in this assessment is accurate and complete to the best of my knowledge.

I understand that providing false information may result in my order being cancelled and may have health implications.

1 About Your Health
2 About Your Condition
3 The Agreement and Consent

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Assessment for Contraceptives

Contraception

1 About Your Health

Question 1:Are you allergic to norethisterone or any other similar hormone medicines?

Yes

Question 2:Women only: Are you pregnant or is there a possibility you may be pregnant?

Question 3:Are you currently taking any other medicines including any herbal remedies? (e.g. St. John's Wort)

Yes

Question 4:Have you ever been advised against using hormonal contraception by a healthcare provider?

Yes

2 About Your Condition

Question 1:What type of contraception are you interested in?

Question 2:What is your primary reason for seeking contraception?

Question 3:If you have chosen "Other (please specify)" for your reason for seeking contraception, please specify here.

Question 4:Do you have a history of sexually transmitted infections or concerns about your sexual health?

Question 5:Have you previously used any form of contraception?

Yes

Question 6:Do you have a regular menstrual cycle?

No

Question 7:Have you experienced any unusual symptoms, such as abnormal bleeding, severe abdominal pain, or unexplained weight changes?

Yes

Question 8:Have you had a recent check-up with a healthcare provider regarding contraception?

3 The Agreement and Consent

Question 1:Understanding of Risks

Question 2:Medical Guidance

Question 3:Consent to Share Information

Question 4:Confirmation

Assessment Progress

Quick Links

Acid Reflux

Acne

Anxiety

Erectile Dysfunction

Hair Loss

Period Delay

Weight Loss

Ear Wax Removal

Repeat Prescriptions Service

NHS Contraception Service

Travel Clinic

Assessment for Contraceptives

Contraception

1 About Your Health

Question 1:Are you allergic to norethisterone or any other similar hormone medicines?

Yes

Question 2:Women only: Are you pregnant or is there a possibility you may be pregnant?

Question 3:Are you currently taking any other medicines including any herbal remedies? (e.g. St. John's Wort)

Yes

Question 4:Have you ever been advised against using hormonal contraception by a healthcare provider?

Yes

2 About Your Condition

Question 1:What type of contraception are you interested in?

Question 2:What is your primary reason for seeking contraception?

Question 3:If you have chosen "Other (please specify)" for your reason for seeking contraception, please specify here.

Question 4:Do you have a history of sexually transmitted infections or concerns about your sexual health?

Question 5:Have you previously used any form of contraception?

Yes

Question 6:Do you have a regular menstrual cycle?

No

Question 7:Have you experienced any unusual symptoms, such as abnormal bleeding, severe abdominal pain, or unexplained weight changes?

Yes

Question 8:Have you had a recent check-up with a healthcare provider regarding contraception?

3 The Agreement and Consent

Question 1:Understanding of Risks

Question 2:Medical Guidance

Question 3:Consent to Share Information

Question 4:Confirmation

Assessment Progress

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