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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 via email - it may go to junk mail / spam folder so please check those.


Please read all the information carefully and complete all fields. If you have NOT used the medication before, you will be prescribed the lowest / starting dose. If you have used the medication before, there is a section to upload your proof of usage. Failure to upload your proof will delay your order.

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

Please enter your address. This will be the address your

item is shipped to. Please ensure it is correct.

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