Consultation

Consultation

About You


 

Please provide your weight.

 
 

 

Please provide your height.

 
 

 
Do you smoke or drink?


Do you take any medication whether prescribed, over the counter, herbal/alternative or partake in any recreational drug use?

Do you have any allergies?


Have you been advised to avoid strenuous exercise?

Are you able to walk 3 miles or climb a set of stairs without pain in your chest?

Do you have any history of symptoms of anxiety or depression?

 

About your symptoms

Have you ever had an allergic or anaphylactic reaction to eflornithine (Vaniqa) or any other creams?

Have you previously received a test to measure your testosterone or 17-hydroxyprogesterone levels?

Have you noticed any of the following symptoms
(Please select all that apply.)

Have you been told by your doctor that you have adrenal hyperplasia?


Do you suffer from excessive hair growth in certain areas of the body?

Has your doctor told you that you have an androgen-secreting hormone or Cushing’s syndrome?

Are you currently receiving any medications or treatment for facial hirsutism?

Do you have polycystic ovary syndrome (PCOS)?

Are you postmenopausal?

Have you been diagnosed with facial hirsutism by your doctor?


a. Are you pregnant or planning a pregnancy? (yes/no)
Taking Semaglutide/Ozempic/Saxenda whilst trying to conceive or during pregnancy can cause a risk to the unborn foetus. It is important to stop such medications at least 2 months prior to trying to conceive or as soon as you discover you are pregnant. Please get in touch if you have any questions.

b. Are you breastfeeding?

 
 

GP Details

Would you like us to inform your GP of your treatment?
 
We recommend informing your GP surgery of any treatment that you are taking to keep your medical records relevant and up to date

 

Agreement

Do you agree to the following?
  • You have answered all of the above questions accurately and truthfully. You understand our prescriber(s) will prescribe medication based on your responses and interactions with Quick Meds. Any incorrect responses or deliberate acts to misinform may be hazardous to your health.
  • You agree to the terms and conditions, privacy policy and terms of use.
  • You will familiarise yourself with the patient information leaflet included with your order and any other information relayed to you via other means including IM/E-mail/telephone.
  • You will contact us and inform your GP if you experience any side effects to treatment, if there are any changes to your medical history including starting any new medications or new diagnoses, or if your symptoms/medical conditions change in any way.
  • You understand completing a purchase does not guarantee supply of treatment; the final decision to prescribe lies with the prescriber with your best interests, health and appropriateness in mind.
  • You agree to the terms and conditions, privacy policy and terms of use.