Your 2 minute consultation

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You'll need

Before you get started, it's a good idea to make sure you have the following information to hand:

  • Weight and height
  • Photo of your face
  • Photo of your ID

About you

Our doctors need to learn a little bit about you to help understand your condition.

What's your biological sex?

  • Male
  • Female

Cellphone number (mandatory)

e.g.5556661234. Please do not add +1. Enter only 10 digits, no spaces. * By entering your number, you agree to receive mobile messages related to your order.

What state do you live in?

What's your date of birth?

What do you weigh?

How tall are you?

Your health

We need to see if your medical history could affect the treatment options.

Do you smoke?

On average, how many units of alcohol do you drink in a week?

If you're not sure, you can calculate the number of units using our guide here: How many units of alcohol do I drink?

Do you have any known allergies to any medications or substances?

Are you pregnant or planning to become pregnant?

Are you currently breastfeeding?

Do you have any of the following conditions?


Heart disease

High blood pressure (hypertension)

Peripheral artery disease




Learning disability

None of the above

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

Do you have any other health problems or conditions that you think we should know about?


These questions let our doctor know how Insomnia affects you

Which of the following insomnia symptoms do you experience?

Trouble falling asleep

Trouble staying asleep

Fatigue or malaise

Poor attention or concentration

Problems socially

Mood disturbance or irritability

Daytime sleepiness

Reduced motivation or energy

Increased errors or accidents

Hyperactivity, impulsivity, or aggression

Constant worry about sleep

None of the above

How long have you had a problem falling asleep or staying asleep?

How many times a week do you have a problem falling asleep or staying asleep?

Have you previously tried any insomnia treatments such as counseling, meditation, over-the-counter medication, prescription medication, or dietary supplements?

Do you experience any of the following conditions?



Post-traumatic stress disorder

Substance use disorder

Other sleep disorder


Pulmonary disease



Neurogenic disorder

None of the above

Is there any other information you would like to share with us, to help our doctors make an informed and fair decision?

Your consent

We need to make sure that you are aware of and agree to some criteria before you choose your medicine.

I agree to the terms and conditions

  • I confirm I am 18 years old or above
  • I am using this service on my own behalf and of my own free will and any treatment or advice is for my sole use only
  • I understand my consultation will not be passed to the Medzino clinical team until I have successfully completed payment
  • I will read the patient information leaflet supplied with the medicine or obtain it from the Mezino website; especially 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 Medzino terms and conditions.
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