Assessment for Vaginal Dryness

Prescribed or non-prescribed

• Do you understand that you should read the patient information leaflet included with your medicine before using it, as it contains the most up-to-date information on how to use it safely, including the side effect and risk profile?
• Do you understand that vaginal oestrogen is a low-dose, local treatment and works mainly in the vaginal area?
• Do you understand that it may take a few weeks to notice improvement and that regular use is needed?
• Do you understand the importance of keeping up to date with routine health screening, including breast screening and cervical screening, as recommended for you?
• Do you understand that you should contact the pharmacy or your GP if you have any concerns or notice any new or unusual symptoms while using this treatment?
• Do you understand that you should seek medical advice if symptoms do not improve, worsen, or if you develop any serious or urgent symptoms including unexplained vaginal bleeding?

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

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.