Contraception Treatment (Pill, Patch or Ring)

A licensed doctor reviews your answers before issuing this prescription.

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01Details

Prescription

Contraception Treatment (Pill, Patch or Ring)

€25 — reviewed by a licensed doctor before your prescription is issued.

Patient details

Patient full nameEmailPhone

Date of birth

Enter a date up to 17/10/2026.

PPS number (optional)

Needed on medical documents in your country. You can also fill it in on your profile later.

Preferred pharmacy (optional)

Type at least 2 characters to search.

My pharmacy is not listed

IE · Contraceptive · Full

This form is reviewed by an Irish-registered doctor before any prescription is issued. Please answer every question fully and honestly.

Which method are you requesting?

Do you smoke?

Do you get migraines?

Personal or family history of blood clot (DVT/PE), stroke, or heart attack

Height and weight

Height (cm)

Weight (kg)

Your health

Blood pressure

Breast cancer or unexplained vaginal bleeding

Postpartum / breastfeeding status

Could you be pregnant right now?

Diabetes

Are you taking St John's Wort, or epilepsy, HIV or rifampicin-type medication?

Patient address

Required for medical documents and any physical materials.

Street addressApt / unit (optional)CityEircode (optional)

Data sharing consent (GDPR)

I confirm the details above are accurate and consent to a video consultation with the selected clinician.I consent to my personal and medical data being processed by Global Health and shared with its treating clinics and medical network — including clinics in other countries — for the purpose of my care, service improvement, and security. Privacy PolicySend me appointment updates via WhatsApp (optional)