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?

Yes No

Could there be any chance that you may be pregnant?

Yes No

Are you currently breastfeeding?

Yes No

Do you have epilepsy?

Yes No

Do you have history of any psychiatric illness including depression?

Yes No

How many do you smoke a day?

Are you taking insulin, warfarin, theophylline?

Yes No

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

Yes No

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

Yes No

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

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