Female Patients - Application for Contraceptive Pill and Patch (archive)


What is the Contraceptive Pill?
The combined contraceptive pill or ‘the pill’ is a type of medication that prevents against pregnancy. It can be used to treat heavy periods, painful periods, PMS or premenstrual syndrome, and endometriosis. It can also improve acne. A woman gets pregnant when a man’s sperm meets one of her eggs.

To prevent pregnancy, the pill keeps the sperm and egg apart, by stopping ovulation, by making it harder for sperm to get to an egg and by making it harder for a fertilised egg to implant in the lining of the womb. The combined pill contains synthetic versions of the female sex hormones oestrogen and progesterone.
Order your repeat prescription for the contraceptive pill online and save yourself time and hassle!
Our service is suitable for women who have been taking an oral contraceptive pill for at least three months.
Complete our brief medical questionnaire, then our doctor will review your request and check whether you can continue taking your pill

   Dr. Jody Shanahan-Prendergast


Irish Medical Council Register Number: 425861

How it Works?
Just €25 (100% money back guarantee).
Online consultations with Irish based doctors.
Discretely posted in a plain envelope with no branding.
Our doctors issue a 6 month prescription if medically safe and suitable.
Valid in any Irish pharmacy to buy your medication.
Delivery through the post usually within 2 business days after approval.
Fax service for urgent requests available at no extra cost, simply ask the doctor in your secure patient record after you apply.
No risk, 100% refund if our Doctors cannot help you.
The information that you provide is covered by the same patient-doctor confidentiality as in a normal face to face consultation.


What contraceptive would you like a prescription for? *

By whom was this last prescribed for you? *

Are you currently using the treatment you have requested? *

How long have you been using this treatment? *

Have you had any side-effects from this contraceptive? *

Are you using this medicine for any other reason than contraception? *

Were you ever advised by any healthcare provider (Doctor, Nurse or Pharmacist) that you should avoid use of these treatments (Pill or the Patch or the Ring)? *

Are your periods regular? *

Was there anything unusual with your last period? *

Have you had any unusual or irregular vaginal bleeding (E.g. after sexual intercourse or between periods)? *

During your last cycle of treatment did you forget any pills or were you more than 12 hours late taking any pills or have any problems using your Nuvaring or Patch in the prescribed manner? *

Have you had any vomiting or watery diarrhoea in your last cycle of treatment? *

Have you had any vomiting or watery diarrhoea in your last cycle of treatment? *


What is your birth sex? *

What is your age? *

Do you smoke? *

Have you ever had a blood clot? *

Have you ever had cancer? *

Have you any history of recurring severe headaches or migraines? *

Have you ever had liver problems? *

Have you ever been diagnosed with heart disease, high blood pressure or have you ever been prescribed treatment for high blood pressure? *

Have you any history of diabetes or high blood sugar levels? *

Have you ever had a cervical smear? *

YES, I HAVE, please specify when:

What was the smear result? *

Are you pregnant? *

Are you planning to become pregnant within the next six months? *

Are you breastfeeding at the moment? *


In your immediate family (mother, father, brothers and sisters) is there any history of cancer? *

In your immediate family (mother, father, brothers and sisters) is there any history of a stroke or brain haemorrhage or heart disease under the age of 45? *

In your immediate family (mother, father, brothers and sisters) is there any history of a clot in the legs, lungs or blood under the age of 45? *

Other than issues already mentioned, do you have any other significant medical conditions, illnesses or past surgical procedures? *

Can you tell us your current height (enter as centimetres)?

Can you tell us your current weight (enter as kg)?

When did you last have your blood pressure taken? *

If known, please specify eg 120/80 mmHg:

Are you currently or in the last two months have you taken any medicine (prescribed or not), alternative medicines or recreational drugs other than those you have mentioned previously? *

Do you have any sensitivity to medicines or any allergies? *

Please specify what allergies you have. Select "NO KNOWN ALLERGIES" if no. *

I confirm that I have read and understood this and my answers are fully correct and true. *