Have you created registered a profile with us yet?
Please register your profile before completing the screening questionnaire. The assessment will help our medical expert to determine if it is safe to prescribe contraceptives for you or not.
How old are you?
Choose your age range
Do you smoke?
What is your weight?
Please select your weigh in Kg's from dropdown menu
Are you pregnant?
When was your last period?
Have you ever been diagnosed with any of the below listed illnesses?
If yes, please consult with a doctor prior to completing the online assessment
Which birth control option do you prefer?