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Register - New Customers
Please register first to obtain treatment
Registration is free and without obligation to order

Registration Explained

To continue your order, please complete the registration form, this will take about 2 minutes. The information is for the sole use of the Doctor to assess your condition and approve you for treatment if applicable. The information will not be used for any other marketing purposes whatsoever.

For further information, please check our registration FAQ's.
Registered with the care Quality Commission

Questions Related to Quit smoking

In order to prescribe treatments for Quit smoking our doctor needs some information regarding this specific condition. Please complete the following as accurately as possible.

How long have you been a smoker?

Why do you want to quit smoking?

Have you tried to quit smoking before, if so how?
       

Could there be any chance that you may be pregnant?
       

Are you currently breastfeeding?
       

Do you have epilepsy?
       

Do you have history of any psychiatric illness including depression?
       

How many do you smoke a day?

Are you taking insulin, warfarin, theophylline?
       

Do you suffer from sever renal impairment (kidney problems) or do you get dialysis?
       

Are you currently taking, doing or using anything to help you stop smoking?
       

Please confirm that you are aware that treatment with Champix should be stopped if agitation, depressed mood or changes in behaviour are causing concern
 

 

© 2004 - 2018 FMC Marketing Limited, UK CQC-registered company working with medical professionals GMC registered doctors and UK-registered pharmacies.
Our Doctors:
Doctor Nitin Shori (Clinical Lead) - GMC Reference Number: 6047293
Doctor Alexandra Phelan - GMC Reference Number 6150198

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FMC Marketing Limited is registered in England No. 04780577 Registered address; Hampshire House, 204 Holly Road, Aldershot, Hampshire, GU12 4SE