Medical questions

Consultation for:
General health questions

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.

1
What is your gender?
2
Do you need help completing this form?
Please contact us on 020 7538 4139 or email [email protected] and we can assist you.
3
What is your date of birth?
4
What is your current weight?
Stone
Pounds
5
What is your height?
Feet
Inches
6
Is there anything else you would like to include for the prescriber?

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Specific health questions
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