Before you start

This form is for adults aged between 18 and 50 who would like to request treatment to delay their period for a short time, for example for a holiday, event, or special occasion.

Your answers will be reviewed by one of our Independent Prescribing Pharmacists, who will decide whether treatment is safe and appropriate for you. We may contact you if further information is needed.

Completing this form does not guarantee treatment will be supplied. If treatment is not suitable, we will advise you on the next steps where appropriate.

How we use your information

• Used only to assess your suitability and provide care
• Stored securely in line with UK data protection requirements
• Accessed only by authorised healthcare professionals
• Not shared with third parties unless required for your care or by law

See our full Privacy Policy HERE
.