Simple Online Pharmacy

There are NHS prescriptions in your basket. Please complete the order first or remove NHS prescriptions from the basket.

Ordered Before? Log in now, and save time completing your assessment.

1About you

What was your sex registered at birth? (i.e. your biological sex) *

Are you currently prescribed HRT by your GP or specialist? *

NoYes

Please provide more information *

Do you currently have or have you previously been diagnosed with any medical conditions? *

NoYes

Please provide more information below. *

Have you currently or have you ever been diagnosed with any mental health conditions? *

NoYes

Please provide more information below. *

Do any of the following apply to you:

You are pregnant or think you may be pregnant
You have undiagnosed abnormal vaginal bleeding
You have suffered a blood clot or heart attack in the last 12 months
You have active liver disease or abnormal results from a liver blood test
You have suspected or active womb or breast cancer

NoYes

Please provide more information below: *

Are you currently taking any medication? *

NoYes

Please provide more information below. *

Do you have any known allergies? *

NoYes

Please provide more information below. *

What is your current blood pressure? *

You must have a current blood pressure reading before you can continue

Please provide your height and weight? *

Height (cm) *

Please ensure you enter your correct height as this can't be changed for future orders

Weight (kg) *

Height (feet) *

Weight (stone/pounds) *

BMI

Body Mass Index

Are you ordering, or currently taking, Evorel Conti? *

NoYes

Has it been more than 18 months since your last menstrual period? *

NoYes

Has it been more than 12 months since your last menstrual period? *

NoYes

Are you ordering oestrogen-only HRT today? *

NoYes

2Your Health

Have you had a recent review of your HRT in the last 12 months? *

NoYes

Please provide more information below. *

Have you had any unexpected vaginal bleeding in the last 12 months? *

NoYes

Please provide more information below. *

Have you had a hysterectomy (womb removed)? *

NoYes

Did you have your ovaries removed too? *

NoYes

If you answered yes to either of the above two questions, please provide more details (when, why etc) *

Are you currently prescribed a progestogen medicine? (e.g. Mirena coil) *

NoYes

What progestogen medicine are you currently taking? *

Have you had a coil fitted? *

NoYes

What type of coil is it (hormonal or non-hormonal)? When was it fitted? *

Do you have a family history of cancer (particular ovary or breast)? *

NoYes

Please provide more information below. *

Have you had any form of cancer (particularly - Breast/Womb/Cervix/Ovary)? *

NoYes

Please provide more information below. *

3Menopause Symptoms

Do you suffer from vaginal dryness? *

NoYes

Please provide more information below. *

Do you experience regular urine infections? *

NoYes

Please provide more information below. *

Do you experience hot flushes? *

NoYes

Please provide more information below. *

Do you experience any difficulty sleeping? *

NoYes

Please provide more information below. *

Do you experience any changes in your mood? *

NoYes

Please provide more information below. *

Is there any other information you feel would be useful for our clinicians to know about? *

NoYes

Please provide any additional information below: *

4Acknowledgements

We strongly advise that you inform your GP of any treatment you receive.
Would you like us to inform them on your behalf?

NoYes

Please enter your postcode to display your local GP's

Please enter your GP’s name and surgery address. Please also enter their email address and fax number, if you know it.

You can find your GP surgery information details below

Please enter your GP surgery name *

Please enter your GP surgery address and post code *

Please enter your GP surgery email *

Please enter your name *

Please enter the address registered with your GP. *

Please enter your date of birth *

I confirm I am over 18 years old.
I confirm this treatment is for me, and I consent to this treatment.
I will read the patient information leaflet supplied with the medicine specifically the side effects and dosages.
I take responsibility to inform my own regular doctor of the online consultation or any changes in my circumstances.
I agree to the Simple Online Pharmacy terms and conditions. *

Confirm

If treatment is not suitable, you will be refunded and signposted to another point of care. The decision about the treatment is for both the patient and the prescriber to consider, however, the final decision will always lie with the prescriber.

Cancel AssessmentCancel Assessment

Assessment Progress

NHS Prescriptions made Simple

Assessment

1About you

2Your Health

3Menopause Symptoms

4Acknowledgements