Your Health

  • Mucous from the back passage
  • Blood coming from the penis
  • Bad smelling vaginal discharge
  • Vaginal bleeding not related to your period
  • Severe pelvic pain or a high temperature

Medical Condition

  • Kidney disease
  • Liver disease
  • Heart disease
  • Systemic Lupus Erythematosus (SLE)
  • Myasthenia Gravis
  • Alcohol dependency
  • Benign intracranial hypertension

Medication

(Select Yes if any apply)

  • Warfarin or other blood thinners
  • Retinoids (e.g. Isotretinoin, Acitretin, Alitretinoin, Tretinoin tablets)
  • Ciclosporin
  • Lithium

Agreement

  • You will read the patient information leaflet supplied with the medication
  • You will contact us or your GP if you experience side effects, start new medication, or your health changes
  • The medication is for your personal use only
  • You confirm that all answers provided are accurate and truthful

GP Consultation

We can notify your GP of your treatment for you. To do so, we need their contact information. Sharing this information allows your GP to maintain a comprehensive record of your medical history, which is crucial for your health. Without complete records, there could be potential risks to your well-being.