Generic emergency contraception

Generic condoms small

Generic condoms medium

Generic condoms large

Generic condoms mixed

Progestogen only pill

Genital chlamydia and gonorrhoea test

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Yes, I have had my normal period or bleed

No, but this is normal for me (because of my contraception or another reason)

No, I have not had a bleed and this is not normal for me

Have you had a normal period or bleed in the last 6 weeks?

You have told us that you have not had a period in the last 6 weeks and that this is not normal for you. Please tell us more about this.

Please tell us more.

When did your last period start?

Have you had unprotected sex more than once since your last period?

When did you most recently have unprotected sex?

Since your last period, when was the first time you had unprotected sex?

Are you breastfeeding or chestfeeding?

Have you had a baby in the last 21 days?

What was the date you gave birth?

In the last 5 days, have you had an abortion, miscarriage, ectopic pregnancy or uterine evacuation for gestational trophoblastic disease?

Can you tell us when this happened?

Have you used any hormonal contraception in the last 7 days or or are you on hormone replacement therapy (HRT)?

Which hormonal contraception or HRT have you used?

 Yes, the 3-day levonorgestrel pill (Levonelle)

Yes, the 5-day ulipristal acetate pill (ellaOne)

In the last 7 days, have you taken an emergency contraceptive pill?

What is your height?

What is your weight?

Are you allergic to lactose?

I can tolerate the small amounts of lactose in pills

I can NOT take pills with small amounts of lactose

Can you tolerate small amounts of lactose?

Are you allergic to peanuts?

Are you allergic to soy?

I can take medication that contains soybean oil

I have a severe nut allergy and need to discuss alternative options

Do you need soy-free medication?

Are you allergic to oestrogens in combined hormonal contraceptives?

Are you allergic to progestogens in hormonal contraceptives?

Are you allergic to doxycycline?

Are you allergic to azithromycin?

Are you allergic to aciclovir?

Are you allergic to podophyllotoxin?

Are you allergic to imiquimod?

Are you allergic to any other medications or foods?

What are you allergic to?

Are you currently taking any medication or herbal remedies?

What medication or herbal remedies are you taking, and what conditions are you taking these for?

Have you ever been diagnosed with liver or gallbladder problems?

Please tell us more about your liver or gallbladder condition, including the diagnosis and any treatments you have had.

Have you ever had any other health conditions, illnesses, major surgery or medical treatment that we should know about?

How would you describe your gender identity?

How would you describe your gender?

Is your gender identity the same as the sex you were assigned at birth?

Which of these describes you best?

How would you describe your sexual orientation?

Does anyone in your life make you feel scared or unsafe?

Do you feel down or depressed?

Is your partner a lot older than you?

Has anyone given you something, like gifts or money, for sex?

Have you been pressured into sex?

Do you feel scared or uncomfortable with anyone you have sex with?

Have you been sexually assaulted?

Some communities practise female circumcision or cutting, where the female genitals are deliberately cut or changed. Has this happened to you?

Are there any girls or young women in your household whose cutting, closing or circumcision might be planned?

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Who do you have sex with?

Are you showing any symptoms of a sexually transmitted infection?

What is your current method of contraception?

Has a nurse or doctor ever told you it is not safe for you to use some methods of hormonal contraception?

Can you tell us more about this?

Have you ever had a blood clot (thrombosis)?

Do you have any conditions that affect your heart or circulation?

Do you have a condition that affects your blood clotting?

Have you been told you have high cholesterol (hyperlipiademia)?

Have you had or do you have breast cancer?

Have you done a genetic test that showed genes associated with a higher risk of breast cancer (BRCA1, BRCA2, or others)?

Do you have discharge, nipple changes or a lump in your breast area and you do not know what's causing it?