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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Born male
Born female






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Please select either Metric or Imperial measurements :

Metric (Centimetre and Kilograms)
Imperial (Feet and Pounds)



Either prescribed or over the counter, including herbal remedies, supplements, or recreational drugs.


This may be to any medicines or other substances e.g. peanuts/soya)




You will need to show us proof before we can issue any medication.

Either:

  • Take a measurement at home using your own blood pressure monitor. You can show us this in the video consultation or send us a picture via email
  • Come down to Pharmacy Advance in Dorking & our pharmacist will measure it for free
  • Go to any pharmacy and send us the form via email. The form must be stamped with the pharmacy details 
  • Go to your GP & send us the details via email


  • Diabetes
  • Migraine headaches
  • Cancer
  • HIV
  • High blood pressure
  • Liver disease







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  • This treatment is solely for your own use
  • You will read the manufacturer’s patient information leaflet and stop and report and adverse effects immediately to the relevant healthcare professional
  • Y0u confirm that you have answered all the above questions accurately and truthfully. You understand our team take your answers in good faith and base their decisions accordingly, and that incorrect information can be hazardous to your health.

Please ensure the medication is stored safely out of reach of young children or pets to prevent accidental ingestion.


Please state your registered GP if you haven't done so already when signing up