The commission will endeavour to contact you at your preferred time but it may not always be possible
Confirmation Required
If you proceed with an order, our doctor will call you on the below number to explain potential side effects and answer any questions you may have. Please ensure that your phone number is correct as the doctor cannot write a prescription without speaking with you first.
Answer seven quick questions about your general health to get the most effective clinically proven treatments for you.
DO YOU AGREE AND CONSENT TO THE FOLLOWING?- I live in Australia.
- I shall be the sole user of any medication offered to me through this service.
- I confirm all answers are provided by me, and will be truthful.
- I agree to the terms and conditions.
Would you like to skip the questionnaire and speak with a Doctor instead?
NEWDo you take any regular medications, have any known allergies or any medical issues?
Please list any regular medications you take, any known allergies or any medical issues.
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Please provide your sex at birth*
How long have you been suffering from Insomnia?*
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Do you have any allergies or special medical conditions? *
Please enter any allergies or special medical conditions *
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Do you take any medications?*
Enter any medications you take or have previously taken *
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Did you get a good result from it? *
Did you have any side effects from it? *
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Are you pregnant or breastfeeding? *
Are you suffering from any mental illnesss *
Please explain what mental illness you are suffering from? *
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Is there anything else you like to tell your Doctor? *
What would you like to tell your Doctor? *
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Please enter your date of birth. *
Discretion is at the heart of what we do but for legal reasons the name on your prescription must be your full legal name. Please provide your legal name as per your official government ID. *
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Based on your medical history and individual needs, our doctors have provided personalised treatment. Please complete your mobile phone number to view recommended treatment. *
Do you have a Medicare card?
Please enter your Medicare Card details
What is your IHI?
Do you have a medication preference?
Enter the name of medication below
Please select your preferred strength
Have you taken 100mg before?
How many uses?
Do you prefer?
Unfortunately based on your answer you would not be suitable for treatment. If you would like to speak with the Burst doctor to discuss other treatment options, please book an appointment here.
If you made a mistake, you can go back and correct your answer.Please follow this link to book a $35 consultation with our doctor:
Click here to book If you made a mistake, you can go back and correct your answer.Thank you for filling out the form.
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