Contraception Oral or Patch

Name

Surname

Phone Number

ID Number

Have you used our services before?

Address

City

Postal Code

Have you used birth control medication before?

When was your last menstrual period?

Do you experience any of these menstrual issues?

Are you pregnant or breastfeeding?

What is your current weight in Kilograms (kg)?

What is your current height in Centimeters (cm)?

Have you taken a blood pressure test in the last 12 months?

Was your latest blood pressure reading NORMAL? (lower than or equal to 139/89 mmHg and higher than 90/60 mmHg)

Do you smoke?

Do you have any of these conditions related to blood clotting?

Do you have any other medical conditions?

I have read and agree to the Terms and Conditions and Privacy Policy (POPI) of the use of this Website and Service. I understand the questions above and have answered honestly. I understand that any inaccurate or false information could potentially be dangerous to my health and safety. The medication that is prescribed is for my personal use only. I understand the side effects and effectiveness of the treatments.I agree to the Terms & Conditions of this platform.I am 18 years or older.I am currently living in Zimbabwe

I Agree to the terms and conditions of this Prescription Application and that of the use of this service.

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US$ 10,00