Birth Control

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What state do you live in?
First, we need to make sure we are licensed in your state.
What state do you live in?*
Unfortunately we cannot service this condition in your state. Please contact your local physician for assistance.
Your state may require a phone or video consultation to complete your treatment. Don't worry! Your doctor will reach out to you if this is the case.

What is your first and last name?
Name*

First NameLast Name

What is your email?
What is your email?*
example@example.com
Type a question*

By Checking Here… You agree to receive doctor correspondence，transactional and/or marketing messaging from MetaHealthRX，to the email address that you provided above.

What is your phone number?
Please enter the best phone number to reach you on just in case the doctor has any questions regarding your medical information.
Phone Number*
Please enter a valid phone number.
Type a question*

By checking this box, I also consent by electronic signature to receive phone calls and/or SMS text messages at the phone number(s) below, including my wireless number if provided. I understand these calls may be generated using an automated technology, pre-recorded voices and that data rates may apply. I understand that my consent is not required to buy goods/services and I may opt out at any time to avoid receiving calls or SMS text messages.
domain*

What is your date of birth?
Birth Date*

MonthDayYear
You must be 18 to order this prescription medication.
today*

MonthDayYear
Date
age*

What is your gender?
What is your gender?*

MaleFemale
Sorry, this treatment plan is only available for females.

Are you currently taking any other prescription medications?
Are you currently taking any other prescription medications?*

YesNo
Please list all prescription medications you are taking or are currently prescribed. Include all over the counter medications, vitamins, minerals, or supplements.
Please list all prescription medications you are taking or are currently prescribed. Include all over the counter medications, vitamins, minerals, or supplements.*
Many medications interact with Birth Control medications. Your doctor wants to be sure of every medication you take. Are you SURE you do not take any other medications?
Yes: I affirm, I do NOT take any other medications.*

Yes: I affirm, I do NOT take any other medications.

Please select a reason for today's visit.
Please select all options that apply to you.
Please select a reason for today's visit.*

Start birth control for the first timeResume using birth control againRefill birth control prescriptionChange birth controlOther
Please provide details for which birth control you have used and why you would like to change.
Please provide details for which birth control you have used and why you would like to change.*
Please provide more details.
Please provide more details.*

Please provide your reasons for seeking birth control.
Please select all options that apply to you.
Please provide your reasons for seeking birth control.*

Prevent pregnancyRegulate periodsReduce crampsBased on doctor's diagnosisTreat skin / acneOther
Please provide additional details.
Please provide additional details.*
Please explain.
Please explain.*
Please provide more details.
Please provide more details.*

Please select any of the following which apply to you.
Please select all options that apply to you.
Please select any of the following which apply to you.*

PregnantBreastfeedingLooking to become pregnant in the next 6 monthsGave birth in the last 6 weeksI’m not sureNone
How long have you been nursing and how is it going?
How long have you been nursing and how is it going?*
pleaseSelectFollowing-IMP*
none_1*
Please uncheck 'None' if you have selected any other options.

We are sorry we cannot help you. This treatment plan does not apply to you.

Have you ever been diagnosed with hypertension?
Have you ever been diagnosed with hypertension?*

Yes (exclusionary for estrogen, premenopausal)No
Please provide details of your hypertension including when you were diagnosed and your treatment plan.
Please provide details of your hypertension including when you were diagnosed and your treatment plan.*
isHypertension-IMP*
conditionDetails_hypertension-IMP

Have you checked your blood pressure reading in the last six months?
Have you checked your blood pressure reading in the last six months?*

YesNo

We are sorry we cannot help you. This treatment plan does not apply to you.

Select your blood pressure reading taken within the last 6 months?
Select your blood pressure reading taken within the last 6 months?*

Very Low

Under 95 top, under 65 bottom
Normal

Under 120 top, under 80 bottom
High

Above 140 top, above 90 bottom
Very High

Above 160 top, above 90 bottom
hasBPR-IMP*

Do you have a preferred method of birth control?
Please select all options that apply to you.
Do you have a preferred method of birth control?*

IUDPatchPillRingShotNo preference
none_2*
Please uncheck 'No preference' if you have selected any other options.

Have you previously used any form of prescription birth control?
Have you previously used any form of prescription birth control?*

YesNo
Please provide details of the birth control you used including how long you used for, whether it was effective, and if there were any side effects.
Please provide details of the birth control you used including how long you used for, whether it was effective, and if there were any side effects.*
prevBCP-IMP*
birthControlTriedDetails-IMP

What is the first day of last period?
What is the first day of last period?*

MonthDayYear

On average, how many days apart are your periods?
On average, how many days apart are your periods?*

We are sorry we cannot help you. This treatment plan does not apply to you.

Do you smoke cigarettes, e-cigarettes, or vapes?
Do you smoke cigarettes, e-cigarettes, or vapes?*

YesNo
Please provide more details including what you smoke and how often.
Please provide more details including what you smoke and how often.*
isSmoking-IMP*
detailsSmoke-IMP

Do you have any other medical conditions?
Do you have any other medical conditions?*

YesNo
Please list all medical conditions you have.
Please list all medical conditions you have.*

Do you have any allergies to food, dyes, medications, or anything else?
Do you have any allergies to food, dyes, medications, or anything else?*

YesNo
Please list all allergies.
Please list all allergies.*

Have you had any surgeries or hospitalizations?
Have you had any surgeries or hospitalizations?*

YesNo
Please specify what surgery or hospitalization you had.
Please specify what surgery or hospitalization you had.*

How long ago was your most recent check up with a physician?
How long ago was your most recent check up with a physician?*

Within past yearWithin 2 yearsWithin 3-5 yearsOver 5 years ago

Did you understand all the questions which were asked?
Did you understand all the questions which were asked?*

YesNo
Which question did you not understand?
Which question did you not understand?*
isUnderstood-IMP*
whichQuestion-IMP

Here's your first message to your doctor.
Please introduce yourself and feel free to:
- Ask any questions you have
- List any medical problem you have which were not discussed above
- Include anything else you would like the doctor to know.
Here's your first message to your doctor.*

0/0
moreToTellDoctor-IMP

Please acknowledge that you understand and agree to the following:

I have filled out a medical intake form that will be used by a board certified physician that is licensed in my state to make a medical treatment plan for me. I understand all the questions that have been asked of me. The information that I have provided is accurate and complete. I am the patient who is consenting to be evaluated for treatment.
Please acknowledge that you understand and agree to the following:*

I acknowledge and agree to the above.

What state do you live in?

What is your first and last name?

What is your email?

What is your phone number?

What is your date of birth?

What is your gender?

Are you currently taking any other prescription medications?

Please select a reason for today's visit.

Please provide your reasons for seeking birth control.

Please select any of the following which apply to you.

We are sorry we cannot help you. This treatment plan does not apply to you.

Have you ever been diagnosed with hypertension?

Have you checked your blood pressure reading in the last six months?

We are sorry we cannot help you. This treatment plan does not apply to you.

Select your blood pressure reading taken within the last 6 months?

Do you have a preferred method of birth control?

Have you previously used any form of prescription birth control?

What is the first day of last period?

On average, how many days apart are your periods?

Do any of the following situations or medical conditions apply to you?

Do you have an aura? Educated on aura

We are sorry we cannot help you. This treatment plan does not apply to you.

Do you smoke cigarettes, e-cigarettes, or vapes?

Are you currently taking any of the following medications or undergoing any treatments?

Do you have any other medical conditions?

Do you have any allergies to food, dyes, medications, or anything else?

Have you had any surgeries or hospitalizations?

How long ago was your most recent check up with a physician?

Did you understand all the questions which were asked?

Here's your first message to your doctor.

Medication we offer: