About the Condition and Treatment
To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.
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Is there a history of jaundice (skin yellowing), liver disease, or liver cancer in your family?
Has your doctor prescribed desogestrel to you while taking anti-diabetic medicine?
Are you suffering from a blood clot (thrombosis) in your leg or lungs, or any of the symptoms (e.g., acute pain)?
Could there be a history of breast, uterine, endometrial, or ovarian cancer, or any other hormone-sensitive cancer, or do you fear you do?
Could you be experiencing any vaginal bleeding that you can't explain?
Do you suffer from any allergies?
If you do, kindly explain them below
Have you or anyone in your family been diagnosed with the following conditions:
- Cancer of the breast, ovary, cervix, or uterus. - Any type of hemorrhage or blood clot (e.g. DVT).- Epilepsy.- Endometriosis.- Varicose veins are a type of varicose veins. Blood pressure that is too high.- The gallbladder or the liver is afflicted.- Fat in the blood is at an all-time high (hyperlipidaemia).- Bleeding from the vaginal area for an unclear reason.- Porphyria or systemic lupus erythematosus.
If you are aware of your blood pressure,how regularly do you visit your doctor to monitor and control it?
Are you aware of how high or low your blood pressure is?
This could be from an examination by your doctor, a certified medical practitioner or self-examination.
Kindly share your weight and height
Height should be above 1 ft 10 inches
Do you get migraines on a regular basis?
Have you noticed anything out of the ordinary regarding your most recent period?
Are there any issues about your relationship or sexual partner(s) that you'd like to talk to a healthcare expert about privately?
For which duration have you used hormonal contraception (pill or patch) in total?
Were you ever warned not to take hormonal contraception (pills or patches) or are you aware of any reason why you shouldn't?
In the recent three years, have you undergone a cervical screening (smear) test?
If not, could you kindly explain why a smear test was not performed?
Are you aware of the following:
It is never a good idea to self-diagnose and treat urine incontinence.
Is your doctor now prescribing Brevinor tablets to you?
Did you know that:
A healthcare practitioner should assess any acute injuries.
Is your doctor now prescribing Desogestrel 75mcg Tablets to you?
Is your doctor now prescribing Cilique Pill to you?
Is your doctor now prescribing Cerelleto to you?
Is your doctor now prescribing Cerazette Tablet to you?
Can we share this information with your General practitioner?
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.
Can you relate to any of the following?
You have an underlying medical condition
Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.
If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option
What is your biological gender?
Please select your option
Can you relate to any of the following statements?
You have or have had stomach or duodenal ulcers, as well as stomach or intestinal bleeding in the past.
Are you on any of the following medications?
Fluvoxamine
Do you remember the last time you had a pill check with your doctor? Please include the month and year in your response.
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