+ UK Registered Pharmacy / We are a registered pharmacy (Reg No. 1042081) with the GPhC
Please fill out the form below so that our clinicians can determine if the treatment will be suitable for you to take.
To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.
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Please answer the following questions to understand more about your specific condition
Please answer the following questions to help us confirm that you'll follow the guidelines for this medicine.
You will read the patient information leaflet supplied with your medication.
You will 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.
You have answered all the above questions accurately and truthfully.
You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.
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