Contraception (Pill, Patch or Ring)

A licensed doctor reviews your answers before issuing this prescription.

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01Details

Prescription

Contraception (Pill, Patch or Ring)

€15 — reviewed by a licensed doctor before your prescription is issued.

Patient details

Patient full nameEmailPhone

Date of birth

Enter a date up to 18/10/2026.

NIF / Cartão de Cidadão (optional)

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

Número de Utente (optional)

Your SNS health number, so the doctor can reach your national health records and issue electronic prescriptions. Leave blank if you don't have one.

PT · Contraceção · Completo

Este formulário é analisado por um médico licenciado antes de ser emitida qualquer receita. Responda a todas as perguntas de forma completa e honesta.

Que método quer pedir?

Fuma?

Tem enxaquecas?

Antecedentes pessoais ou familiares de coágulo sanguíneo (TVP/EP), AVC ou enfarte

Altura e peso

Altura (cm)

Peso (kg)

A sua saúde

Tensão arterial

Cancro da mama ou hemorragia vaginal inexplicada

Pós-parto e amamentação

Pode estar grávida neste momento?

Diabetes

Está a tomar hipericão, ou medicamentos para a epilepsia, para o VIH ou do tipo da rifampicina?

Patient address

Required for medical documents and any physical materials.

Street addressApt / unit (optional)CityPostal code

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)