Stop Smoking Questions

Your Current Health

Do you have an allergy to varenicline tartrate?

Are you breast feeding or pregnant or possibly pregnant?

Do you suffer from any of the following?

  • Kidney (renal) disease
  • Depression, anxiety or other psychiatric conditions
  • History of seizures/epilepsy
  • Diabetes
  • Heart disease/stroke
  • Any serious medical condition which may require immediate hospitalisation

Are you taking any of the following medications?

  • anti-depression medication
  • cimetidine for gastric problems
  • theophylline, warfarin or insulin

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)


Do you understand that when starting Champix treatment you should start with a 2 week starter pack?

Are you aware Champix increases your chances of quitting smoking but you will also need willpower to succeed (help from family and friends will also help)?

Do you understand that you should start taking Champix 1-2 weeks before you stop smoking?

Do you understand that you must stop taking Champix and contact your GP or other urgent healthcare provider if you experience any of the following conditions?

  • new or worse heart or blood vessel (cardiovascular) problems
  • seizures
  • agitatation, depressed mood, changes in behaviour, suicidal thoughts
  • swelling of face, mouth or neck

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

quality products assured across youth revisited

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.