Discreet and confidential delivery

150,000+ trusted patients

9,131 Reviews on TrustPilot

Excellent

image image image image image

Free online consultation

5000+ 5* reviews

Back to Shopping
  • Cart is empty.
image
image
image
  1. Home
  2. Contraceptive Pill
  3. Dianette
  4. Consultation

Your Health

1

Do you believe you have the capacity to make decisions about your own health; and that you do not require help to complete this consultation? *

2

Do you have any concerns about your relationship or sexual partner(s) that you wish to discuss privately with a healthcare professional? *

This can include if you are being pressured into ordering this medication against your will or any other concerns that you feel may be putting you at risk. Support may be available from Women’s Aid.

3

What is your height? *

4

What is your weight? *

5

What is your blood pressure? *

You must have had your blood pressure checked within the last 6 months, and be aware of the results. You are able to get your blood pressure checked at your GP surgery, or your local pharmacy. Can you please let us know what your latest blood pressure reading was. If you have not had your blood pressure checked within the last 6 months, you should have this chec.ked. If you are unsure, please let us know. 

6

Have you had a pill check up with your GP surgery within the last year? *

7

Are you taking Co-cyprindiol primarily to treat acne after having tried rub-on treatments and antibiotics? *

8

What medication have you previously used to treat your acne? *

9

Are you experiencing any of the following? *

  • Cysts or nodules, or acne that is crusting scabbing or bleeding
  • Severe scarring or hyperpigmentation
  • Fever, painful joints, loss of appetite, weight loss or fatigue
  • Severe psychological symptoms such as depression or anxiety

10

Where is your acne? *

11

What best describes your acne? *

If you have nodes or cysts, which appear as large red boils that reside underneath your skin, you should visit your GP or dermatologist. Delaying treatment can cause scarring and topical antibiotics are unlikely to be effective.

12

Are you currently using this medication? *

13

Have you ever experienced any problems with taking oral contraception? *

14

Was there anything unusual about your last period? *

15

Are you up to date with your cervical smears? *

  • Recommended every 3 years for women aged 25-49
  • Recommended every 5 years for women aged 50-64
  • Recommended at frequent intervals for previously abnormal smears
    • If not, please let us know why, and whether you have one booked in.

16

Was there anything abnormal about any of your smears? *

17

Do you smoke, or have you ever smoked? *

18

Do you get migraines? *

19

Have any of your parents, siblings or children had any of the following? *

  • Blood clot under 45 years old
  • Blood clot at 45 years or older 
  • Heart attack or stroke under 45 years old

20

Have you ever been diagnosed with any of the following? *

  • You have a history or family history of VTE (venous thromboembolism), or any blood clotting
  • You have antiphospholipid syndrome
  • You have a condition which affects the way your blood clots, such as factor V Leiden, protein C or S deficiency, antithrombin deficiency, antiphospholipid deficiency, thrombophilia
  • You have a history of heart problems such as arrythmias, heart failure, heart disease, angina, atrial fibrillation, endocarditis or you have had a heart attack
  • You have a history of high blood pressure (including pulmonary hypertension)
  • You have a history of blood cancer, breast cancer including if you are a carrier of BRCA1/2, cervical cancer, ovarian cancer, or any other cancer
  • You have a history of lung disease
  • You have disease of the arteries including high cholesterol or high fat levels in the blood
  • You have had a stroke
  • You have recently had surgery within the last 2 months, or due to have surgery soon
  • You have a history of Crohn’s disease or Ulcerative colitis
  • You have rheumatoid arthritis or any other autoimmune joint conditions
  • You have any other conditions affecting your immune system such as systemic lupus erythematosus
  • You have a history of varicose veins
  • You are immobile or bed bound
  • You have recently had a serious infection
  • You have a history of liver problems or kidney problems
  • You have a history of undiagnosed vaginal bleeding
  • You have a history of acute porphyria or any inherited blood disorders
  • You have a history during pregnancy of jaundice, severe itching, skin blistering, high blood pressure, involuntary or clumsy movements (chorea), or any other complications
  • You have a history of repeated miscarriage
  • You have epilepsy
  • You have severe itching all over your body
  • You have a history of migraine with aura
  • You have had an organ transplant
  • You have a history of gallbladder disease
  • You have a history of sickle cell disease
  • You have had bariatric surgery
  • You have a history of diabetes (including diabetic complications such as nephropathy/retinopathy/neuropathy)
  • You have a history of acute porphyrias
  • You have undiagnosed breast mass
  • You have a history of depression
  • You have a history of inflammation of the pancreas
  • You have HIV

21

Do you have any other medical conditions? *

Please include a history of medical conditions.

22

Do you take any other medication? *

23

Are any of the following true? *

  • You have given birth within the last 6 weeks
  • You are pregnant
  • You are breastfeeding
  • You have taken the emergency contraceptive pill within the last month

24

Do you understand that you must report headaches that are reoccurring, severe or unusual in any way to your GP? *

25

Do you understand that you must report any new medication you are taking to you GP, and make any other prescribers aware that you are taking the pill? *

26

Do you have any allergies to the ingredients contained in the medication, or any other allergies? *

27

Do you understand that you should stop taking the pill and seek urgent medical advice if you experience: *

  • Swelling of your legs or along a vein in the leg or foot. Especially when this is accompanied by pain or tenderness in the leg, increased warmth in your leg, changes in colour of your skin on your leg
  • Sudden breathlessness or rapid breathing, sudden cough which may be blood stained, sharp chest pain, severe dizziness or light headedness, rapid or irregular heartbeat
  • Severe stomach pain
  • Chest pain or discomfort in your chest or arm such as fullness, indigestion or choking feeling, sweating, nausea, vomiting or dizziness
  • Extreme weakness or numbness of your body, anxiety, or shortness of breath
  • Sudden confusion, trouble speaking or understanding
  • Sudden partial or complete loss of vision
  • Loss of balance or coordination 
  • Fainting or seizures
  • Yellowing of the skin, eyes and/or darkening of the urine
  • Itching on your whole body
  • You notice any unexplained vaginal bleeding, pelvic pain or painful sex
  • Your mood changes
  • Increased frequency, length or severity of headaches
  • Sudden disturbance of hearing (or any other perceptual disorders)
  • Abnormal or involuntary movements 
  • A marked increase in blood pressure 
  • You think you are pregnant 
  • You notice any changes to your breasts
  • You notice any signs of an allergic reaction such as swelling of the face, lips, mouth, tongue or throat
  • You experience any other unusual side effects
    • Whilst you should seek urgent medical advice, you should also inform your GP and inform us if you experience any of the above, or any other side effects. You should call 999 in the case of a medical emergency, or 111 for advice. 

28

Is there any additional information you would like to provide, or any questions you have? *

29

Are you aware that? *

  • This service does not replace your regular face-to-face contraceptive pill check up
  • You should take one tablet daily for 21 days, followed by a 7-day break
  • You should take your pill at the same time daily
  • If you miss a tablet, you should read the Patient Information Leaflet in your pack for advice on what to do and whether you still have contraceptive cover
  • Your pill may not be effective if you experience vomiting or diarrhoea and that you should use a condom for 7 days after
  • No contraceptive pill is 100% effective at preventing pregnancy
  • No contraceptive pill can protect you against Sexually Transmitted Infections
  • There is a small risk of serious effects such as blood clots, breast cancer and cervical cancer. You should read the Patient Information Leaflet to spot signs of a blood clot, check your breasts regularly for any abnormalities, and have regular smear tests
  • Hormones in the contraceptive pill may cause depression. You should inform your GP of any changes in mood that may be affecting your daily life
  • You should read the Patient Information Leaflet for common side effects, and report any side effects and changes in your health and body to your GP, and via the Yellow Card Scheme
  • You should visit www.sexwise.org.uk for further information about family planning

30

Do you agree that? *

  • You will read the Patient Information Leaflet supplied with your medication
  • You will contact us and inform your GP if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • You are over 18 and the treatment is solely for your own use
  • You have answered all the above questions accurately and truthfully and that incorrect information can be hazardous to your health
  • You are aware the decision about your treatment are for both the prescriber and yourself to jointly consider during this consultation, but the final decision will always be the prescriber's
  • You will inform your GP that you have ordered this medication
  • You will have an annual pill review with your doctor or nurse
  • By continuing, you agree to our Terms & Conditions, Cancellation Policy and Privacy Policy