Online QUIT.HEALTh Doctor Consultation

Do you smoke and want to quit smoking?* This field is required.

Yes

How Quit Health Works.Click 'NEXT' to agree you understand QUIT.HEALTH and start the process.

E-mail Address* This field is required.

Full Name* This field is required.

Gender* This field is required.

Phone Number* This field is required.

Date of Birth* This field is required.

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Have you previously used Quit Health or any of the Hyphen Health group.* This field is required.

Quit Health

Stigma Health

PrEP Health

No, No problem! Welcome aboard!

Prescribing Exclusion Criteria* This field is required.if any of the following apply to you, you cannot proceed with this service.

Pregnant or Breast feeding

Under 18 years of age.

Previous psychosis diagnosis or requirement of antipsychotic medications

Have you ever required hospital admission for a depressive illness?

Have you ever required hospital admission for mania or bipolar?

Epilepsy

Have you been prescribed Champix (varenicline) in the past 6 months?

Have you ever had an allergic reaction to Champix (varenicline) if used previously?

Are you using any other quit smoking medications accessed via the PBS?

Do you have chronic kidney failure?

None of these apply.

Enlist a support site.* This field is required.The probability of success in quitting smoking increases when you enlist help. It is essential to our program that you sign up to one of the following FREE public smoking cessation supports. Tick one and we will send you sign up information

www.icanquit.com.au

https://www.quit.org.au/make-a-plan/

Collection Method* This field is required.How would you like to collect your prescribed medication? You will be invoiced after the Doctor prescribes. $6.60 per month for concession card holders and $41.30 per month for medicare card holders.

Home Delivery - Australia Post Express Shipping, $15 shipping fee Australia wide.

Collect from Pharmacy - we will send the script to a local pharmacy for you to purchase and buy your medication

Patient Declaration* This field is required.Your digital consultation will be conducted today by our GP Doctor who will review your digital answers and may contact you or the pharmacy directly should he require further clarification. All your answers are stored in a secure and encrypted environment and are kept completely confidential. Please acknowledge you are happy for our GP Doctor to review any information provided by signing below.

ClearPatient Signature (use your finger to sign)

My Products

My Bag

Quit Health Smoking Cessation PrescriptionQuit Health Smoking Cessation Prescription. Prescription only. Medication is on the Pharmaceutical benefits scheme. $6.60 per month concession card holders. $41.30 for Medicare card holders.
$34.99AUD+Edit
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Online QUIT.HEALTh Doctor Consultation

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