Polypill.com

The Concept
- Polypill Prevention Programme
- What is it?
- How does it work?
- Health Benefits Calculator
- Frequently Asked Questions
- Cardiovascular Disease
- About Cholesterol
- About Blood Pressure
Your Health
Headache Prevention
About Us
- Our Team
- Polypill Founders and Doctors
- Details for Health Professionals
- Polypill concept in the press
- Our Website
- Terms and Conditions
- Privacy Policy
Contact

Online Consultation Sign in

Polypill Prevention Programme

Assessment

Please complete this form and click 'Register' to create a polypill.com account. Based on your answers to the questions below, one of our doctors will assess your eligibility for the Polypill Prevention Programme.

Please tick to confirm you have a delivery address in the United Kingdom.

Email

This will be your account username.

Password

Make a note of this password as you will need it to access your account.

Title

Name

Contact Number

Date of birth

Gender

Male Female

Have you ever had a heart attack or a stroke?

Yes No

Have you had a test of kidney function and been told that you had impaired kidney function (e.g. a test that indicated the need for renal dialysis)?

Yes No

Are you taking any prescription medicines, over-the-counter medicines or herbal preparations on a regular basis?

Yes No

Please provide details of the medicines you are taking

Are you allergic to any medicines or other substances?

Yes No

Please provide further details.

Are you pregnant or planning to become pregnant?

Yes No

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

Yes No

Please provide details.

Where did you hear about the Polypill Prevention Programme? This helps us develop the programme.

I agree that it is my responsibility to read all information sent to me as part of my on-line medical record.

I confirm that I have understood all the questions asked and have answered all questions to the best of my knowledge.

Please tick here also to signify that you have read, understand and agree to abide by our terms and conditions and privacy and cookie policy.

Home
Online consultation
Headache Prevention
Contact us

The Concept
What is it?
How does it work?
Health Benefits Calculator
FAQ

Your Health
Your Diet
Exercise and Routine
Smoking and Alcohol

About us
Polypill Founders and Doctors
Terms and Conditions
Privacy and Cookies

Call our doctors on
020 7600 3205

Polypill Prevention Programme prescriptions are dispensed under the supervision of a Cohens Chemist pharmacist. Please ensure you read all medical product packaging, leaflets and labels prior to use.