Please answer the following questions about your general health.
The information you provide us is treated with absolute confidentiality and will be reviewed by our experienced online doctors. We ask the following questions to provide the prescriber with an appropriate level of information to make an informed decision on whether the treatment is suitable or not.
Sorry, we are not able to provide this treatment to patients with the biological sex that you have selected.
Are you currently, or are you planning to become, pregnant or breastfeeding?
Do you need help completing this form?
What is your date of birth?
Do you have any allergies?
Is there anything else you would like to include for the prescriber?
Do you take any of the following medications:
- Cyclosporine (following organ transplants)
- Glucocorticoids (e.g. against rheumatic or allergic diseases)
- Minoxidil (against high blood pressure)
- Phenobarbitone (against seizures)
- Phenytoin (against seizures)
- Hormone replacement therapy with male hormone-like effects e.g. androfem or testogel.
Do any of the following apply?
- You have any medical conditions that you have not already mentioned
- You have, or previously had, any mental health problems that required specialist mental health support or hospitalisation
- You have had major surgery
- You have heart problems or have had a stroke
- You have decreased kidney or liver function
10 questions left