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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.
We ask about your general health, allergies, medical history, and medications to check if contraception is safe and suitable for you.
If yes, please detail them here, otherwise please type N/A
If yes, please provide more information
If yes, please list them here
If yes, please details?
We ask about your contraceptive needs, past use, and any health factors to help match you with the most suitable option.
Preventing pregnancy, managing menstrual cycle irregularities or if other please specify.
If yes, please specify the type and any issues experienced:
Please provide more information
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.
I have been informed about the potential side effects and interactions of the prescribed medication for Contraception.
Confirmation is required for this consultation.
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.
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.
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.
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