Help your pharmacist prepare

Pick what this session is about below, and this takes about 3 minutes.

What’s this session about?

Trying to Conceive

Male Fertility

PCOS

Pregnancy Support

Weight Management

General Wellness

SECTION 1

Your details

First Name *

Last Name *

Email *

WhatsApp Number

SECTION 2

About you

Age range *
Under 2525–2930–3435–3940+

Preferred language (optional)

SECTION 3

Your journey so far

How long have you been trying to conceive? *
Under 6 months6–12 months1–2 years2+ years

How long has this been a concern? *
Under 6 months6–12 months1–2 years2+ years

How long since your symptoms started or diagnosis? *
Under 6 months6–12 months1–2 years2+ years

How many weeks along are you? *
First trimesterSecond trimesterThird trimesterPostpartum

How long have you been focused on this? *
Under 3 months3–6 months6–12 months1+ years

Are you currently taking any medications or supplements related to this? *

Any conditions that might be relevant? *
PCOSEndometriosisFibroidsThyroid conditionNone of these

Any conditions that might be relevant? *
Low sperm countVaricoceleHormonal imbalanceNone of these

Any conditions that might be relevant? *
PCOS (confirmed)EndometriosisThyroid conditionInsulin resistanceNone of these

Any conditions that might be relevant? *
Gestational diabetesHigh blood pressureAnaemiaNone of these

Any conditions that might be relevant? *
DiabetesThyroid conditionPCOSNone of these

SECTION 4

Partner & context

Is a partner involved in this journey? *
YesNoPrefer not to say

Has your partner had a relevant check-up? *
YesNoNot sureNot applicable

SECTION 5

What you want from this session

What would you most like to leave with? (select any) *
Understanding my optionsA product recommendationWhether I need to see a doctorGeneral reassurance

Anything else you'd like your pharmacist to know beforehand? (optional)

I consent to PrimaCare contacting me on WhatsApp or email about this consultation. My information stays private.

Only your pharmacist sees this. It’s never shared or used for marketing.

PrimaCare Pharmacy

Licensed and approved by the Pharmacy Council of Nigeria

1 Nyenweli Nsirim Layout, Tombia Extension, GRA Phase 2, Rivers State.
08033240657