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Morning After Pill Questions

You and your symptoms

Do you need the morning after pill for the following reasons?


  • I recently engaged in unprotected sexual intercourse (24 hours)

Do you or have you suffered from any heart problems stroke, angina or any other heart related problems ?


Are you taking any medication that has been prescribed by your Gp/Doctor or Hospital ?


Do you give consent for us to contact you GP if required? (we need this to process any order for medication)


Current Health

Have you ever had a reaction or allergy with the contraceptive pill or other hormonal medication?


Are you taking any of the following medications?


  • Barbiturates, Primidone, Phenytoin, fosphenytoin, Carbemazepine, oxcarbazepine, (used predominantly to treat epilepsy)
  • Rifampicin or Rifabutin (tuberculosis)
  • efavirenz, nevirapine or Ritonavir (for HIV infection)
  • Griseofulvin (for fungal infections)
  • Ciclosporin
  • Herbal remedies containing St John's Wort, Hypericum perforatum
  • Antacids and anti-ulcer medication

Have you been diagnosed with any of the following?


  • Liver problems
  • Digestive problems or gut absorption problems e.g. Crohn's disease
  • Previous ectopic pregnancy, fallopian tube surgery or pelvic inflammatory disease
  • Women with severe asthma treated by oral glucocorticoid
  • Lactose intolerance

Is there a chance that you may already be pregnant?


  • This could be indicated by changes or interruptions to your menstrual cycle.
  • Levonelle will NOT terminate an existing pregnancy.

Are you breast feeding?


Agreement

I am aware of the following:


  • Levonelle is effective if it is taken within 72 hours of unprotected intercourse and EllaOne is most effective for up to 120 hours (5 days). It may be used between 72 and 96 hours after unprotected intercourse but efficacy decreases with time. If you require the morning after pill immediately you should realise that there may be a delay (depending on your chosen delivery option) before your emergency pill arrives. This means that you risk getting pregnant.
  • If you need the morning after pill immediately you should visit your GP. Alternatively, you can go to your local pharmacy where you can purchase the morning pill over the counter.

Are you aware that 'morning after pills' may not be 100% effective?


  • When taken in the first 3 days after intercourse, pregnancy rates are close to 1.5 in 100 (ellaOne) or 2 in 100 (Levonelle)
  • Levonelle can be taken up to 3 days and ellaOne up to 5 days after intercourse.

Are you aware Levonelle and ellaOne should NOT both be taken in the same menstrual cycle (period)?


  • Take either Levonelle or ellaOne, NOT both.
  • Levonelle and ellaOne should also NOT be taken more than once in the same cycle (period).

Do you agree to the following statements?


  • You must read the patient information leaflet supplied with your medication
  • You must contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • The treatment is solely for your own use only.
  • You have answered all the questions in this short medical assessment accurately and truthfully to the best of your knowledge. You understand our doctor take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.
all of our tests and treatments are price competative

You need to complete our short medical questionnaire so we can ensure the treatment you have selected is safe for you to use

all of our tests and treatments are price competative

Need Help?

If you need help with this medical questionnnaire call us on 07549286701

 
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Quality products

all of our tests and treatments are price competative

Affordable prices

all of our pharmacies and and treatments purchased are from well known and trusted UK pharmacies

UK pharmacy

all of our tests and any other products purchased will be dispatched for a next day service

Express next day delivery

If you have any further questions about any of our products please feel free to contact us and we will do our best to help you.
Once you have your prescription we will be able to process your order through our trusted UK Pharmacy.