Simple Online Pharmacy

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1Your Symptoms

What symptoms are you currently experiencing? *

Vaginal dryness treatments don't treat the other symptoms of the menopause such as hot flushes and sleeping problems. See our online HRT clinic to see the various HRT patches and tablets available.

Could this be a urinary infection or thrush? These conditions can also cause similar symptoms e.g. itching or burning.

Please provide more information below: *

2Your Health

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

Have you noticed any unexpected vaginal bleeding in the past 12 months? *

NoYes

Please provide more information below: *

Do you currently have, or have you ever had: *

Has anyone in your family ever been diagnosed with any of the above cancers? *

NoYes

Please provide more information below: *

Are you currently using any medicine to treat vaginal dryness? *

NoYes

What treatment are you currently using? *

How long have you been using this treatment? *

Do you have any side effects from this treatment? *

Have you ever been diagnosed with a blood clot? (E.g. pulmonary embolism, DVT) *

NoYes

Please provide more information below: *

Do you have any other medical conditions? *

NoYes

Please provide more information below: *

Are you currently taking any prescription-only medicines (including inhalers and creams), alternative medicines or recreational drugs? *

NoYes

Please provide more information below: *

Are you allergic to any medicine or substance? *

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 more information below: *

3Acknowledgements

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 that:

I understand that vaginal dryness symptoms often return if treatment is stopped
I understand that I should see my GP if I experience any vaginal bleeding or spotting
I understand that oestrogen creams and gels can damage latex condoms and diaphragms

Confirm

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 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.

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Assessment Progress

NHS Prescriptions made Simple

Assessment

1Your Symptoms

2Your Health

3Acknowledgements