Name: Qlaira (estradiol valerate and dienogest)
SKU: 540
Availability: InStock

Selected:

Qlaira (estradiol valerate and…

£64.99 – £106.95

Previous Product
Next Product

Qlaira (estradiol valerate and dienogest)

£64.99 – £106.95

Completion of the Medical History questionnaire for this product is mandatory and your purchase is subject to checks by our team.

Strength

Package Size

Clear

SKU: N/A Category: Contraceptive Pill

Additional information

Additional information

Strength	3mg
Package Size	84, 168

Have you seen your GP about your condition? *
What diagnosis was given for your condition? *
Do you give the prescriber permission to contact your GP should an issue arise? *
Enter the practice/surgery you are registered to: *
Are you currently taking any medication prescribed by a doctor, purchased over the counter or homeopathic? *
Which medication, what strength and how often were you taking it? *
Do you suffer from any allergies? *
What allergies do you have and what are the symptoms you experience from an allergic reaction? *
Provide a history of your symptoms, how and when it started, and how it affects your normal daily activities. *
Height (ft) *
Weight (kg) *

Contraceptive Pill
I confirm that my blood pressure is within the range 140/90 to 90/60. * We can't supply you with this medication if your blood pressure is not within this range. Please consult your GP for more information.
I confirm I have not suffered from any heart, liver or kidney problems * We can't supply you with this medication if you have suffered from any heart, liver or kidney problems. Please consult your GP.
I confirm I have never suffered from a stroke or heart attack. * We can't supply you with this medication if you suffered from a stroke or heart attack. Please consult your GP.
When was your last gynaecological check? *
Have you ever used any form of hormonal contraception before? *
When did your last period begin? *
Was your last period late? *
Please enter more details about why your last period was late *
I confirm I am not pregnant, breastfeeding or trying to conceive. * We can't supply you with this medication if you are pregnant, breastfeeding or trying to conceive. Please consult your GP.
Do you suffer from migraines or severe headaches, liver disease or high blood pressure? *
I confirm I have never been advised by a doctor not to take any hormonal contraceptives. * We can't supply you with this medication. Please consult your GP.
I confirm I do not have or ever had Crohn's disease, Ulcerative Colitis, hypertriglyceridemia or pancreatitis. * We can't supply you with this medication if you have or ever had Crohn's disease, Ulcerative Colitis, hypertriglyceridemia or pancreatitis. Please consult your GP.
I confirm I do not have vaginal bleeding and the cause of the bleeding is not known. * We can't supply you with this medication if you have vaginal bleeding and the cause of the bleeding is not known. Please consult your GP.
I confirm I have never experienced experienced a blood clot such as a swollen leg, stroke or heart attack. * We can't supply you with this medication if you have ever experienced a blood clot. Please consult your GP.
Do you smoke? *
I confirm no one in my family ever suffered from thrombosis, breast cancer or cancer of the cervix, uterus or vagina. * We can't supply you with this medication if you have family history of thrombosis, breast cancer or cancer of the cervix, uterus or vagina. Please consult your GP.
Is there any other medical information relevant to your condition that you think our doctor should consider? *
I confirm that the contraception is for my own use and I understand no contraception is 100% effective. *

Qlaira (estradiol valerate and…

Qlaira (estradiol valerate and dienogest)

Contraceptive Pill

Additional information

Related products

Rigevidon

Zelleta

Marvelon (ethinylestradiol and desogestrel)