Ella Birth Control Questionnaire

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Help us personalize your care by answering a few quick questions. It only takes a couple of minutes to complete.

6 Questions

Contraceptives Ella Purchased

When was the first day of your last period?

Are you currently breastfeeding?

Yes

Are you over 195 lbs.?

Yes

While there is some concern that emergency contraceptives are not as effective with females who are over 195 pounds.

Have you used emergency contraception in the past 30 days?

Yes

Please know that this medicine cannot be used within the same menstrual cycle. Also, it may diminish the therapeutic effect of Plan B and vice versa, so you should not take these two medicines within the same menstrual cycle either.

Are you taking any of the following medication: barbiturates (phenobarbital and other meds that end with -barbital), bosentan, carbamazepine, felbamate, griseofulvin, oxcarbazepine, phenytoin, rifampin, St. John’s Wort, or topiramate?

Yes

How often do you have intercourse monthly?

Less than 12 times a month

12-24 times a month

More than 24 times a month

Information about yourself

Gender assigned at birth

Male

Female

Unfortunately, we are unable to provide this service for you. Please see your provider in person for care.

Are you pregnant?

Yes

Unfortunately, we are unable to provide this service for you. Please see your provider in person for care.

First Name

Last Name

Online Prescriptions For Travel Sickness Medicine

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