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Period Delay Tablets Norethisterone
Do you believe you have the capacity to make decisions about your own healthcare?
YES
NO
Have you been diagnosed with any medical conditions?
YES
NO
Please provide more information, including diagnosis, symptoms and treatment.
Have you ever been diagnosed with a mental health condition?
YES
NO
Are you currently taking any medication? This includes prescription-only, over-the-counter and homeopathic medicines.
YES
NO
Do you suffer from any allergies?
YES
NO
Do you suffer from any allergies?
YES
NO
Why are you requesting period delay medication?
Are you currently using regular contraception?
No
Yes, I use a combined pill/patch
Yes, I use a mini pill/implant/injection or coil
Do you experience irregular bleeding or spotting between your periods?
YES
NO
Are you currently breastfeeding, pregnant or actively trying for a baby?
YES
NO
Have you ever had migraines?
YES
NO
Do you ever get severe headaches at the front/side of your head, with nausea/vomiting, increased sensitivity to light or sound?
YES
NO
Have you or anyone in your family ever had a blood clot (e.g. DVT or PE); or have you had major surgery in the last 3 weeks?
YES
NO
Have you ever suffered from any of the following: cancer, diabetes, epilepsy, kidney problems, liver problems, asthma
YES
NO
Do you smoke?
YES
NO
Has your blood pressure been checked in the last 12 months?
YES
NO
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