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.

0%








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

0%




This includes the following scenarios:



- Did the unprotected sexual intercourse occur more than 5 days ago?

- Is your period currently more than 7 days late?

- Have you previously within this cycle had unprotected sexual intercourse without regular contraceptives?


This includes but is not limited too things such as:



- Uncontrolled or severe asthma

- Crohn’s disease

- Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption

- Liver problems
- Fallopian tube surgery
-Previous ectopic pregnancy
-Pelvic inflammatory disease



Rifamycins – RIfabutin and Rifampicin
• Coumarins or Phenindione
• St Johns Wort
• Antiepileptics – Carbamazepine, Eslicarbazepine, Oxcarbazepine, Perampanel, Phenobarbital, Phenytoin, Primodone, Rufinamide, Topiramate, Barbituates
• Antivirals – Efavirenz, Nevirapine, Ritonavir
• Aprepitant
• Bosentan
• Cytotoxics – Rizotinib, Vemurafenib, Dabrafenib
• Ciclosporin
• Griseofulvin
• Selegiline
• Ulipristal




0%



- I am between the ages of 18 and 75

- This treatment is for my use only

- I have the capacity to make decisions about my own healthcare

- I have understood all the questions and have answered this consultation truthfully and completely

- I understand the prescriber will use my answers and base their prescribing decisions accordingly, and that providing incorrect information could be harmful to my health

- I will read the patient information leaflet supplied with this medication

- I will contact we prescribe and inform my GP if I experience any side effects from this treatment or if there are any changes to my health

- I have read, understood and agree with our Terms and Conditions