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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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Everyday
Once or twice a week
Once a week
At least two weeks
On a monthly basis
A few times a month



Gagging
Vomiting
Dizziness
Diarrhoea











Presently Pregnant
Presently Breastfeeding
Planning on getting pregnant
Neither Pregnant nor Breastfeeding

Male
Female
Transmale (Born a female)
Transfemale (Born a male)

























Please answer the following questions to help us confirm that you'll follow the guidelines for this medicine.

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