Question 1 of 12
Is this a medication that you have been taking regularly?
Question 2 of 12
Do you have any side effects from the medication?
Question 3 of 12
How long have you been on this medication for?
Question 4 of 12
Is the medication a controlled substance, a sedative or a medication that requires regular blood test monitoring?
Question 5 of 12
Who is your regular prescriber for this medication?
Question 6 of 12
Please provide clear details on the medication required and dosage
Question 7 of 12
What do you take this medication for?
Question 8 of 12
Do you have any other health conditions?
Question 9 of 12
Do you take any other medications?
Question 10 of 12
Do you have any allergies?
Question 11 of 12
Is there any further information you would like to provide?
Question 12 of 12
Would you like to have a video or telephone consultation?