Do you agree and consent to the following?
- You are completing this consultation for yourself and to the best of your knowledge.
- You will disclose any medical conditions, serious illnesses or operations you have had.
- You will disclose any prescription medications you are currently taking and agree to use only one weight loss treatment at a time.
- You agree to our Terms & Conditions, Terms of Sale, and confirm that you have read our Privacy Policy.
- Your accurate and honest responses to this online questionnaire for weight loss treatment are crucial. Withholding or providing false information can severely harm your health and may result in life-threatening consequences. By filling out this questionnaire, you confirm that your responses are truthful and accurate, acknowledging the potential risks of misinformation.
- You agree to undergo identification and age verification. This may require submitting valid documents to our approved third-party verification partner for validation.
- You consent to EveryDayMeds accessing your Summary Care Record (SCR) for the purpose of ensuring the safe supply of treatment. If the SCR is unavailable or incomplete, you agree to participate in appropriate two-way communication (e.g. phone, secure message, or video consultation) to verify your medical history. If you do not respond or engage, your order will be cancelled.
Your Health
Medical Condition
- Kidney problems
- Liver problems
- Heart problems
- Autoimmune conditions (e.g. Rheumatoid arthritis, Graves’ disease)
- Galactose intolerance or glucose-galactose malabsorption
- Alcohol dependency
- Depression treated with medication
- Schizophrenia or bipolar disorder
- Epilepsy or history of seizures
Medication
Melatonin can enhance drowsiness and lower blood pressure when taken with certain medicines. If you are on any of the medications listed below and experience light-headedness, dizziness, or extreme sleepiness, you must stop taking Melatonin and seek medical advice:
- Alcohol
- Alpha-blockers (e.g. Doxazocin, Alfuzosin, Tamsulosin, Prazocin)
- Tricyclic antidepressants
- Antihistamines
- Antipsychotics
- Myelosuppressive drugs
- Baclofen
- Beta-blockers
- Calcium-channel blockers
- Clonidine
- Diazoxide
- Diuretics
- Guanfacine
- Hydralazine
- Lofexidine
- Methyldopa
- Minoxidil
- Mirtazapine
- Moxonidine
- Nitrates
- Opioid analgesics
- Phenobarbital
- Primidone
- Ritonavir
- Sodium nitroprusside
- Tizanidine
Agreement
- You will read the patient leaflet provided with your medication
- You will contact your GP if you develop side effects or start new medication
- This treatment is for your own use only
- You have answered truthfully
- You understand that clinical decisions rely on the accuracy of your answers
- The final decision to issue a prescription rests with the prescriber
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.