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Weight Assessment

Please ensure you enter accurate height and weight details as this may affect future prescribing decisions

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Your BMI:

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About You

About Your Health

  • Liver problems
  • Acute porphyria
  • Current breast cancer
  • Idiopathic jaundice
  • Pemphigoid gestationis
  • Severe pruritus
  • Thromboembolism or family history of it
  • Undiagnosed vaginal bleeding

About Your Medications

About Your Agreement

  • You have capacity to understand all about the condition and the treatments available here.
  • The treatment for your own use only.
  • You have read and understood what the treatment options / benefits and risks / side effects associated with them.
  • You agree to read the patient information leaflet before taking the treatment and use the treatment as directed.
  • You will contact your doctor if you experience any adverse effects or symptoms change following the start of treatment.
  • You have answered the assessment questions accurately and honestly.
  • You acknowledge there is an increased risk for blood clots if you take norethisterone and your BMI is above 30.
  • You acknowledge there is an increased risk for blood clots if you take norethisterone and you are a smoker.
  • You give permission to access your NHS Summary Care Records (GP records) if required or applicable.