In this phase, we gather details about your general health to identify any potential risks or contraindications related to contraceptive use. This includes questions about allergies, medical history, and current medications. Your responses help ensure the medication is safe and suitable for your overall health.

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If yes, please specify.

Select all that apply.
["High blood pressure"
"History of blood clots (e.g.
deep vein thrombosis
pulmonary embolism)"
"Heart disease"
"Stroke"
"Migraine with aura"
"Liver disease"
"Breast cancer (current or past)"
"Unexplained vaginal bleeding"
"Diabetes with complications"
"Severe kidney disease"
"None of the above"]



["Anticonvulsants (e.g.
phenytoin
carbamazepine)"
"Antibiotics (e.g.
rifampicin
rifabutin)"
"St John’s Wort"
"Antiretroviral therapy for HIV"
"None of the above"]



This phase focuses on your specific contraceptive needs and any factors that might influence the effectiveness or safety of the medication. Questions include your reasons for seeking contraception, previous use of contraceptives, menstrual cycle regularity, and any recent symptoms or health concerns. This helps tailor the medication to your unique circumstances.

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If yes, which method?

If yes, did you experience any side effects?

If yes, please specify:

["Combined Oral Contraceptive Pill (COC)"
"Progestogen-Only Pill (POP)"
"Patch"
"Injection"
"Implant"
"IUD (Copper Coil)"
"IUS (Hormonal Coil)"
"Not Sure"]



The final phase confirms your understanding of the consultation process and your consent to proceed with the purchase. You will also agree to provide accurate information and acknowledge the importance of consulting a healthcare provider if side effects occur or the medication does not meet your needs.

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I confirm that the information I have provided in this form is accurate to the best of my knowledge. I understand that providing false or incomplete information may affect the safety of my treatment.

I understand that no contraception is 100% effective, and I may still become pregnant. I confirm that I do not have any medical conditions that would prevent me from safely using hormonal contraception. I understand that some forms of contraception may cause side effects such as headaches, nausea, or mood changes. I understand that hormonal contraception does not protect against sexually transmitted infections (STIs).

I agree to report any severe or prolonged side effects to my GP or pharmacist. I understand that if I experience symptoms such as severe headaches, chest pain, leg swelling, or sudden vision changes, I must seek immediate medical attention. I understand that certain medications may reduce the effectiveness of hormonal contraception.

I am requesting contraception for the purpose of pregnancy prevention. I have had the opportunity to ask questions and understand the risks and benefits. I accept full responsibility for using this medication as advised.