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Please answer all of the following questions:
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DO YOU HAVE OR HAVE YOU EVER HAD: (Please check all that apply)
ARE YOU USING ANY OF THE FOLLOWING:
ARE YOU ALLERGIC TO OR HAVE YOU HAD AN ADVERSE REACTION TO:
(Please Check All That Apply)
If you are using Oral Contraceptives, it is important that you understand that antibiotics (and some other medications) may interfere with the effectiveness of oral contraceptives. Therefore, you will need to use mechanical forms of birth control for one complete cycle of birth control pills, after the course of antibiotics or other medication is completed. Please consult with your physician for further guidance.
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