Consultation Form

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This questionnaire is essential for your consultation today. Please be truthful and include any current medications, medical history, and other relevant information. This helps our prescribers offer the best advice and medication for your needs. Read all medical information before selecting your treatment.

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I confirm that all previous answers still apply, and that I am not taking any new medication not stated in my assessment. I also confirm that the medication previously prescribed was effective and that I suffered no serious side effects from the medication.