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
  • Photo of your previous prescription or dosage label on the bottle

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?

Use kg

How tall are you?

Use cm

Your health

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

Are you currently a smoker?

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?

Have you ever had, or do you currently have, any of the following conditions:

Heart disease or a recent heart attack (within the past 2 weeks)

A diagnosis of coronary artery disease

A history of open heart surgery

Chest pain (i.e. angina pectoris) at rest or with activity

An abnormal heart rhythm (arrhythmias)

Severe jaw disease (i.e. temporomandibular joint disease)

Seizures or epilepsy

Stomach or intestinal ulcers

High blood pressure

None of the above

If you have experienced any of the conditions listed above, please describe your conditions and any treatment or you are receiving or have received. Please also list any medications you are currently taking.

If you have not experienced any of the listed conditions, please enter NA.

Have you been diagnosed with any of the following psychiatric conditions:

Depression

Anxiety

Panic attacks

Suicidal thoughts or plans to harm yourself

None of the above

What were you diagnosed with? When were you diagnosed? Are you currently receiving any treatment or taking any medications for any of the above conditions?

If you have not experienced any of the listed conditions, please enter NA.

Have you experienced any of the following conditions in the last 6 months?

Unexplained fevers

Unexplained or unintentional weight loss

Night sweats

Coughing up blood

Difficulty speaking or swallowing, or a change in the quality of your voice

Drooping of one eyelid (ptosis)

None of the above

Are you pregnant or planning to become pregnant?

Are you currently breastfeeding?

Do you suffer from any conditions which may affect your kidneys or liver?

Have you had a blood pressure test within the last 6 weeks

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

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

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

Quit Smoking

These questions let our doctor know how Quit Smoking affects you

How many cigarettes do you smoke a day?

How long have you been smoking?

Do you smoke your first cigarette within 30 minutes of waking up?

Do you use any other forms of nicotine or tobacco?

Cigars

E-cigarettes or vaping

Chewing tobacco

Pipe

Snuff

Bidis

Kreteks

None of the above

Have you tried to quit smoking before?

Have you previously tried using Bupropion to quit smoking?

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

Your consent

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

Please review your consultation

I understand that Medzino will only provide this medication for smoking cessation and not depression. If you are requesting this for depression, you will be denied.


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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