• Important
  • Your condition
  • Medical History
  • Consent
Our doctors would now like to check your suitability for this product

How did you hear about us?

I confirm the above statements are true This questionnaire forms the basis of your online consultation. Please be honest and if you are unsure about any of your answers, please verify the information with your GP before using the service:

--I am 18 years old or above.
--I am using this service on my own behalf and of my own free will. Any treatment or advice is for my sole use only.


We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

What is your sex?

What is your date of birth?

Which part of your body is affected by excess hair growth?

Have you noticed an unusual and sudden growth of hair in the last few months?

What does the excess facial hair look like?

Do you still have periods?


We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

Current and recent use of medicines

Are you taking any prescription-only medicines, over-the-counter medicines, alternative medicines or recreational drugs?


Allergies

Are you allergic to any of the following? Please select all that apply.

Do you have any other known allergies?


Your medical history

Have you ever been diagnosed with a kidney condition?

Have you ever been diagnosed with a liver condition?


Pregnancy and breastfeeding

How do I know if I\'m pregnant?

Are you breastfeeding?

Other than those already mentioned, do you have any other significant medical conditions, illnesses or past surgical procedures?


Your height and weight

Please enter your height(cm).

Please enter your weight(kg).


We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

Informed consent

I confirm the above statements are true --I have responded honestly and provided complete and accurate information that reflects my up to date medical history and information, so that the doctor can safely assess and advise me.
--I fully understand all the questions and information provided. If I am unsure about any aspect of the service I will contact Your Chemist Online Doctor before proceeding.
--I understand the side effects, effectiveness and alternatives to the treatment I am requesting.
--I understand this consultation will form part of my Online Doctor medical record and will be kept in line with the relevant retention period.
--I have read, understand and agree to the latest terms and conditions and privacy policy


0% of questionnaire complete