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[% total_qty %]
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  Total: [%% basket.cost_subtotal|multi_currency %%]

Online Appointments
- - Online Appointments - Coming Soon!
  GPs
- Psychologists
- - Frequently Asked Questions
    View all
  FAQ
- - Why choose Simple Online Doctor
    
    Our AHPRA registered health professionals are online and ready to help
    
    Australian Registered
    
    Convenient
    
    Easy to use
  Why Us
- - How it Works
    
    Make Appointment
    
    Make an appointment with one of our health experts for an online video consultation
    
    Information
    
    Complete a form to give us some information about why you want to chat to a doctor, and complete payment for your appointment
    
    Get Online
    
    Just be online at the correct time, and start your online consultation with one of our GPs
    
    Find Out More
  How It Works
Online Scripts
Medications
FAQs

Assessment Progress

1Your smoking history
2Your health
3Consent

Assessment

Ordered Before? Log in now, and save time completing your assessment and confirm you have verified your ID.

Item added to bag. Click here to view bag.

Please select a size from above to proceed.

There are NHS prescriptions in your basket. Please complete the order first or remove NHS prescriptions from the basket.

Patient Notice! This questionnaire forms the basis of your stop smoking consultation today. We need you to be honest with your answers including any current medication you are on. This allows our doctors to prescribe medication that helps you and offer accurate advice. We expect you to read the medicinal information provided before selecting your treatment.

1Your smoking history

READ >>> Top tips for stopping smoking.

Have you previously been prescribed your selected medication by your regular GP? *

No Yes

If you have not previously been prescribed this medication, please refer to your GP for treatment.

How long have you been smoking? *

How many cigarettes do you smoke a day? *

Do you have any known allergy to Champix (Varenicline) *

No Yes

Unfortunately, we can not prescribe you Champix in this instance. Please see your GP for further options in quitting smoking.

2Your health

Have you been diagnosed with a psychiatric disorder such as depression, anxiety or panic attacks? *

No Yes

Unfortunately, we can not prescribe you Champix in this instance. Please see your GP for further options in quitting smoking.

Do you suffer from any problems with your kidneys or your liver? *

No Yes

Unfortunately, we can not prescribe you Champix in this instance. Please see your GP for further options in quitting smoking.

Do you have any of the following conditions? history of seizures/epilepsy ***diabetes ***heart disease/stroke *** *

No Yes

Unfortunately, we can not prescribe you Champix in this instance. Please see your GP for further options in quitting smoking.

Are you currently taking any prescription-only medicines, alternative medicines or recreational drugs? *

No Yes

Please give more details *

Are you currently pregnant, planning to become pregnant or breastfeeding? *

No Yes

Unfortunately, we can not prescribe you Champix in this instance. Please see your GP for further options in quitting smoking.

Please confirm you understand the following; You will stop Champix and contact your GP if you develop agitation, low mood or think you might be experiencing depression **** If you develop swelling of the face, mouth or neck **** if you develop Seizures

No Yes

Please confirm you understand the following? I am aware tha a starter pack is used first to build up dose. ***I am aware that I still need to exercise will power in stopping smoking *** I am aware that I must start taking champix 1-2 weeks BEFORE stopping smoking

No Yes

3Consent

I confirm I am over 18 years old.

The medicine ordered is for my sole use only.

I will read the patient information leaflet supplied with the medicine specifically the side effects and dosages.

I take responsibility to inform my own regular doctor of the online consultation or any changes in my circumstances.

I agree to the Simple Online Doctor terms and conditions. *

Confirm

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