Your Health
The information you provide us is treated with absolute confidentiality and will be reviewed by our experienced UK prescribers. We ask the following questions to provide the prescriber with an appropriate level of information to make an informed decision on whether the treatment is suitable or not.
What is your gender?
Please provide more detail.
Do you need help completing this questionnaire?
Please contact us on 020 7157 9759 or email [email protected] and we can assist you.
Do you believe that you have the capacity to make decisions about your own healthcare?
Sorry we can't offer you this treatment, please contact your GP.
Have you been diagnosed with any medical conditions?
Are you currently taking any medication? This includes prescription-only, over-the-counter and homeopathic medicines.
Do you suffer from any allergies?
Please provide details including which allergies and what symptoms you experience.
Is there anything else you would like to include to allow our prescriber to prescribe responsibly?
Medical Questions
Do you have high cholesterol?
Why are you looking for treatment for high cholesterol?
Have you been diagnosed by a doctor?
Please tell us how you know you have high cholesterol
When was the last time you had your treatment reviewed by your doctor or clinician?
This would normally include blood pressure check, liver function test and cholesterol level test.
Please tell us what your most recent cholesterol reading was if you know it
Do you smoke?
Do you regularly drink more than TEN alcoholic drinks per week?
One alcoholic drink is:
Do you understand that:
Please enter your height and weight
What is your height (cm)?
What is your height (feet)?
What is your weight (kg)?
What is your weight (stone/pounds)?
BMI
Please upload a picture of a box of your medication with the pharmacy label clearly shown.
This is optional, however your order will be delayed if you do not upload a photo and you:
A picture will help our healthcare team to make an appropriate decision about your treatment.
Consent
Would you like us to notify your GP of the treatment you chose to order today?
Please provide details.
It is very important that your GP is aware of all the medication you are taking, so that you are receiving the best possible care. You should only select “no” if you are completely sure you do not wish us to tell your GP.
Do you agree to the following:
If treatment is not suitable, you will be fully refunded and signposted to another point of care. The decision about the treatment is for both the patient and the prescriber to consider, however, the final decision will always lie with the prescriber.
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