UKMedix Secure Order

Step 2 - Read Our Waiver

Please click here to read the associated waiver with this consultation.

Step 3 - Answer the Medical Questionnaire

Please help us by answering a few simple questions about your medical history. Ukmedix has fully qualified GP's who will use these to enable their diagnosis and treatment of you. All answers are held in the strictest confidence.

When was your last gynecological check-up? *
Have you been prescribed with this medication (Noriday) before? *
Have you ever been diagnosed with High blood pressure? *
Your sex? *
Choose the statement that best describes your situation: * Further info:
Have you ever experienced any side effects while using a contraceptive pill/ring/patch? * Further info:
Are you pregnant or breastfeeding? *
Have you, or anyone in your family, ever suffered from thrombosis, liver disease, breast cancer or cancer of the cervix, uterus or vagina? *
Have you ever experienced severe migraines when using contraceptive pills? *
Are you overweight or obese (BMI over 25)? *
Do you suffer from diabetes? *
Have you ever been advised by a doctor not to take a hormonal contraceptive? *
Is there a history of disorders in your family (medical or otherwise)? * Further info:
Do you suffer from any allergies or experience allergic reactions? (e.g. hayfever, peanuts, penicillin) * Further info:
Are you currently taking any medication? (please include both prescription medication and OTC medicines e.g. St. John's wort) * Further info:
Is there anything else which you feel we should know about regarding your medical condition and request for treatment? (e.g. any major surgeries, physical abnormalities, general medical problems not covered above) * Further info:
It is in your best interests if a doctor who prescribes for you can share information with your regular GP, e.g. by telling him or her what has been prescribed for you. If you agree that the prescriber can share information with your GP, please signify your consent by filling in his/her name and address here. (optional)
Have you read, understood and accepted the terms within the Noriday waiver? Click here to read the waiver. *

Fields marked with * are required.

Treatments

Need Help?

Get In Contact with UKMedix

0203 286 3349

(24 hour support, 7 days a week)

enquiries@ukmedix.com

UKMedix Internet Limited
Suite 3, Churston House
Portsmouth Rd.
Esher
KT10 9AD
England

Order Total	£39.95
Delivery	FREE