○ I have NOT had any recent unexplained vaginal bleeding (eg. after sexual intercourse or between periods)
○ I have NOT had any unexpected changes in my bleeding pattern

○ Stroke/mini stroke/TIA
○ Heart attack or any other heart condition, disease of heart valves or blood vessels
○ High blood pressure (hypertension)
○ Atrial fibrillation (AF)
○ A blood clot in my legs or lungs (DVT or PE)

○ Smokers
○ Overweight
○ Immobile, eg. on a long flight
○ Recovering from major surgery
○ Prone to recurrent miscarriages

○ I am not currently being treated for severe depression
○ My mobility is NOT reduced for any reason (eg. Wheelchair use, Illness, Recent surgery)
○ I do NOT have any condition that increases my risk of having a blood clot
○ Nobody in my close family (parents, brothers, sisters) has had a blood clot, stroke, heart attack or arterial disease before the age of 45

○ Migraine with aura that first occurred whilst taking the mini-pill (aura means disturbance of vision, numbness, one-sided limb weakness, or unusual sensations occurring prior to the headache) ( What is migraine with aura? )
○ Liver disease such as cirrhosis, hepatitis, liver tumours or jaundice (yellow skin or eyes)
○ Diabetes/high blood sugar
○ Severely raised cholesterol or triglycerides

○ I have never had any form of cancer
○ I have never had breast cancer

○ Pregnancy related cholestasis (abnormal liver blood tests during pregnancy)
○ Rheumatic disease such as lupus
○ Porphyria
○ Any problems with malabsorption ( coeliac disease, ulcerative colitis, lactose intolerance, intestinal damage, cystic fibrosis, parasitic diseases, tropical sprue, Whipple’s disease, short bowel syndrome, after radiation therapy, after bowel surgery)

○ TB medication
○ Epilepsy medication
○ HIV medication
○ Oral Antifungal tablets (eg. Griseofulvin)
○ Anticoagulants (Blood thinners, eg. Warfarin)
○ Drugs that reduce your immunity (Immunosuppressants, eg. Cyclosporin)
○ St John’s wort (an over-the-counter medication for depression)
○ Parkinson’s disease medications Lamotrigine, Rifampicin, Rifabutin, Carbamazepine, Eslicarbazepine, Oxcarbazepine, Phenobarbital Phenytoin, Primidone, Rufinamide, Topiramate, Bosentan, Modafinil, Aprepitant, Sugammadex

○ I am 18 years old or over.
○ The medication is to be used only by me
○ I will read the drug information sheet and make myself aware of all possible side effects
○ I have no known allergy to the medication selected
○ I take responsibility for informing my regular GP of this consultation & any subsequent health issues
○ I understand the limitations of an automated consultation
○ I am aware that this may not replace the need for a face to face consultation and examination with my GP
○ If I have any concerns about any aspect of my health I will consult with my regular GP
○ I agree to the terms and conditions