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Do you live in England?

The NHS pharmacy contraception service is only available in England

Yes

Please enter your Full Name?

Your full name must match your GP records.

Are you biologically female?

Yes

Please enter your NHS number below?

(optional — this helps us process your order faster) - Not sure where to find it? Check any NHS letter, prescription slip, or your NHS app.

Date Of Birth

Do you feel safe in your personal relationships and living situation?

Yes

Please enter your contact number in case we need to reach you?

Please make sure your phone number is correct and answer the pharmacist’s call, as this may delay your order if we cannot contact you.

A pharmacist may need to call you before your order can be approved. What is the best time to call you?

You must answer the pharmacist’s call or return the call. If we cannot reach you, your order may be delayed.

Are you using any contraception currently?

Yes

I understand that a copper intrauterine device (Cu-IUD), if fitted within 5 days of unprotected sex or within 5 days of the earliest estimated ovulation, is the most effective form of emergency contraception.

Yes

Are you above 70kg in weight?

(70kg = 11 Stones)

Yes

When did you have unprotected sex?

Date

Time

Are you pregnant or breastfeeding?

Yes

Have you had the morning after pill in the same menstrual cycle?

Yes

Do you give consent for us to inform your GP?

If you give consent for data sharing, the information you provide will be passed to: your GP. To inform your GP that you have received oral contraception through the NHS Pharmacy Contraception Service. If you DO NOT give consent we will not share the information with your GP.

Yes

DrPillmans

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Morning After Pill Consultation