Online Consultation Form

This health form will be used by our partner pharmacy to assess your safety & suitability to use the medication.

At the end of the form, you will have the option to pay now or you can wait & an invoice will arrive from PayPal to your email address - it may go to junk mail / spam folder so please check those.


Please complete all the required fields and read all the information thoroughly.

If at any point you are unsure of anything, please contact us or book in for a telephone consultation.