Simple Online Doctor

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We strive to provide safe and effective treatments to improve your sleep and overall health. Our doctors at Simple Online Doctor will never prescribe sleep medicines that have the potential for addiction or reliance. If you require a hypnotic medicine or benzodiazepine for sleep, please refer to your regular GP for treatment.

1Your Sleep

Select one or more of the following that describes your current sleep situation *

Difficulty falling asleepDifficulty staying asleepWaking up during sleeping time followed by being unable to get back to sleepUnable to sleep through the night or waking earlyOther

Please provide more information below. *

How long have you had sleeping difficulty? *

How often per week do you find you have difficulty sleeping? *

What best describes your current sleep type? *

Do you find you have enough time to allocate to a full night of sleep? *

NoYes

Leaving yourself enough time to allocate to sleep can improve well-being and anxiety around getting to sleep. We recommend attempting to free up more time to get the amount of sleep you can feel rested with.

How many hours do you generally sleep per night? *

This medicine must not be taken if you have alcohol in the blood or intend to drink alcohol within 5 hours after taking the medicine. Please confirm you are aware of this health advice. *

Confirm

Do you drink more than 3 caffeinated or energy drinks per day or drink them close to when you plan to sleep? *

NoYes

Caffeinated drinks and energy drinks may be affecting your ability to sleep. Try to cut down on these drinks, particularly when close to the time you intend to sleep. Read more about sleep hygiene here.

Do you take naps close to your intended sleep time? *

NoYes

Taking naps too close to sleep time may cause difficulty sleeping. Read more about sleep hygiene here.

Have you ever been diagnosed with the following:

Sleep Apnoea
Restless leg syndrome
Sleepwalking
Narcolepsy

NoYes

Please provide more information below. *

Do you snore loudly or have been told you snore loudly and occasionally stop breathing or splutter/ cough? *

NoYes

Please provide more information below. *

Have you tried prescription melatonin previously? *

NoYes

Did you experience any side effects? *

NoYes

Please give more details on the side effects you experienced. *

Was prescription melatonin effective in assisting with sleep? *

NoYes

Please provide more information below. *

2Your Health

Based on BMI, are you considered obese (a BMI over 30)?

NoYes

You can access a BMI calculator here if you are unsure.

A raised BMI can cause sleep problems in some people. Consider speaking to a doctor about weight loss to further assist with sleep and general health.

Do you have any diagnosed mental health conditions such as depression, anxiety, schizophrenia, ADHD or bipolar? *

NoYes

Have you been previously prescribed melatonin while being treated for your mental health condition? *

NoYes

Please provide more information below. *

Is your diagnosed mental health condition currently stable and being effectively treated? *

NoYes

Please provide more information below. *

Have you recently felt in low moods, a loss of interest in activities, hopelessness, irritability or anxiety for a prolonged period of time? *

NoYes

This may be a sign of an undiagnosed condition. Refer to your doctor and discuss how you are feeling. If you do not feel comfortable contacting a doctor, please call Beyond Blue at 1300 22 4636 or Lifeline at 13 11 14.

Are you taking any of the following medicines?

Any Quinolone antibiotics such as Ciprofloxacin, norfloxacin and moxifloxacin.
Carbamazepine or Rifampicin
Fluvoxamine
Methoxypsoralen
Cimetidine

NoYes

Please provide more information below. *

Are you taking any hypnotics, tranquilisers, or benzodiazepines? *

NoYes

Please provide more information below. *

Are you currently taking any prescription-only medicines, alternative medicines or recreational drugs? *

NoYes

Please list any prescription, over the counter or alternative medicines you are taking, including the dose. *

Do you have any known allergies to any medications or substances? *

NoYes

Please list any known allergies. *

Do you have any of the following problems or conditions:

Kidney problems
Liver problems
Autoimmune disease
Galactose intolerance, lactase deficiency or glucose-galactose malabsorption

NoYes

Please provide more information below. *

Do you have any other health problems or conditions that you think we should know about? (e.g. Chronic pain, any enzyme deficiencies or recent major operations etc.) *

NoYes

Please enter any health conditions or recent major events. *

Are you pregnant or planning to become pregnant or breastfeeding? *

NoYes

Please provide more information below. *

I confirm I understand that Melatonin may result in natural drowsiness and I should not drive or operate machinery while under the effects of melatonin. *

Confirm

It is recommended to engage in at least 30 minutes of exercise per day to aid sleep.

3Consent

I confirm I am over 18 years old.

The medicine ordered is for my sole use only.

I will read the patient information leaflet supplied with the medicine specifically the side effects and dosages.

I take responsibility to inform my own regular doctor of the online consultation or any changes in my circumstances.

I agree to the Simple Online Doctor terms and conditions. *

Confirm

We strongly advise that you inform your GP of any treatment you receive.
Would you like us to inform them on your behalf? If you are unsure, you can search your GP clinic information by clicking here.

NoYes

Please enter the email address of your GP clinic *

As per Australian telehealth guidelines, all first time patients, those requesting a new treatment or those looking to renew a prescription must have a brief video or phone call with one of our doctors. Do you have reliable access to the internet on a device which you can use to have a video conversation with our doctors? *

NoYes

You require reliable access to the internet on a device which you can use to have a video consultation with the doctor in order to be suitable for telehealth. Please refer to your regular GP in person.

During your consultation, our doctor will assess whether you are suitable for treatment. If you are, a prescription will be provided to and filled by our pharmacy partner and delivered to your chosen address. Any and all resupplies will be stored on your account and will be available for request from our service when required. For resupplies you will only need to pay for the medication and shipping, you will not be charged a consultation fee. Please confirm you understand this information. *

Confirm

If we are unable to assist via a telehealth consultation, you may be asked to seek alternative medical care such as that of a doctor in person. If this occurs you will receive a refund on your request.

Simple Online Doctor is a private clinic; the consultation and medication may be eligible for rebates through your private health cover, but are not covered by Medicare or the PBS. We conduct regular price reviews to ensure we are providing among the best value online.

Did you have difficulty understanding the English that is written in this assessment, affecting your ability to provide accurate answers or do you require language interpretation during a verbal consultation? *

NoYes

As you have difficulty understanding the assessment and or require interpretation services, you will be required to have an interpreter with you during your consultation with the doctor. You can access these services at Translating and Interpreting Services. Please confirm that you agree to organise an interpreter for your consultation.

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