HRT Treatment - Overall - Online Doctor & Pharmacy UK | Free Delivery

9

Has your own GP previously prescribed this treatment for you?

Yes

No

10

Are you currently going through the menopause?

Yes

No

11

When was your last menstrual period?

12

Do you have a uterus (womb)?

Yes

No

13

Are you currently pregnant?

Yes

No

14

Are you using a coil?

Yes

No

15

Do you have a history of blood clots?

Yes

No

16

Are you currently taking any female hormones such as HRT or the contraceptive pill?

Yes

No

17

Have you had a GP review of your HRT within the last 12-months?

Yes

No

18

Do you suffer from recurrent chest pain or have a history of heart attacks or strokes?

Yes

No

19

Have you noticed any unexpected vaginal bleeding in the last 12 months?

Yes

No

20

Have you been diagnosed with breast cancer? or have a family history of breast or endometrial (womb) cancer?

Yes

No

If yes, please provide details

21

Are you suspected to have estrogen-dependent cancer?

Yes

No

22

Do you have any other medical conditions not mentioned already?

Yes

No

23

Are you experiencing vaginal dryness?

Yes

No

24

Are you experiencing pain during intercourse?

Yes

No

25

Are you experiencing recurrent urine infections?

Yes

No

26

Are you experiencing hot flushes?

Yes

No

27

Do you have difficulties sleeping?

Yes

No

28

Have you noticed changes in your mood?

Yes

No

29

Do you agree to undergo the following regular checks:

I Agree

Blood pressure check and blood test
Cervical smear
Breast screening or mammogram/breast ultrasound

30

When was your last gynaecological check or cervical smear test?

31

When was your last breast examination or mammogram?

32

Have you had your blood pressure checked with your own GP within the last 12-months?

Yes

No

33

Due to recent changes in online prescribing of certain medication, we are required you to agree to send us proof that you have previously had this treatment from your own GP. This can either be a copy of your repeat prescription list from your last GP prescription, or a picture of your old treatment pack, clearly showing the dispensing label with your name.

I Agree

You can send a copy of the proof to: [email protected]

Medical questions

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