Assessment for Contraception

I have been informed about the potential side effects and interactions of the prescribed medication for Contraception.

I understand that hormonal contraception does not protect against STIs

I understand the missed pill rules and when to seek medical advice 

I agree to consult with my healthcare provider before starting any new medication. 

I agree to seek medical advice urgently if I develop severe side effects, new or worsening migraines (especially with aura), chest pain, shortness of breath, leg swelling, sudden vision problems, or signs of an allergic reaction. I agree to stop the medication and contact a healthcare professional immediately if these occur.

I understand that the information provided in this assessment will be reviewed by a licensed pharmacist before my order is processed. 

I consent to my personal and medical information being used to assess my suitability for the prescribed medication.

I understand that my information will be kept confidential and used solely for the purpose of this assessment. 

I confirm that the information provided in this assessment is accurate and complete to the best of my knowledge.

I understand that providing false information may result in my order being cancelled and may have health implications.

I agree to read the patient information leaflet in full before starting my new medicine