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.

0%

Born male
Born female




0%


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)


Yes
No
Not Applicable

  • Irregular vaginal bleeding
  • Abnormal vaginal bleeding or a blood-stained discharge
  • Ulcers, blisters, or sores of the vagina or vulva
  • Lower abdominal pain
  • Pain or difficulty in passing urine
  • Fever or chills
  • Feeling sick or vomiting
  • Diarrhoea
  • A foul-smelling discharge from the vagina







0%

  • 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.