Your health and safety are our top priorities. To ensure we provide you with the most effective and appropriate treatment, it is crucial that you provide accurate and complete information about your health during our online consultation process. Accurate information helps us understand your condition better, assess any potential risks, and recommend the best possible medication for your needs. Providing false or incomplete information can lead to inappropriate treatment, potential health risks, and delays in receiving the care you need. Thank you for your cooperation and trust in our services.

0%

Please use the following format 00/00/0000


If yes, please provide details

Male
Female
Transmale (Born a female)
Transfemale (Born a male)

Please provide details in this box here...

If yes, please list them.


If yes, please provide details

If yes, please list them.



If yes, please list them:


If yes, please provide details

If yes, please provide details:





If yes, how often?



Daily
Weekly
Rarely
Never

If yes, please provide details


If yes, please provide details

Acne
- Itchy skin without inflammation
- Itching around any private parts
- Infected skin
- Flushing of skin on or around your nose (rosacea)
- Spotty red rash around your mouth (perioral dermatitis)










Accurately describing your condition during our online consultation is essential for ensuring you receive the best possible care. Detailed and truthful information about your symptoms, their frequency, and their severity allows our healthcare professionals to make informed decisions about your treatment. Incomplete or incorrect descriptions can result in inappropriate medication, potential health risks, and delays in your care. Your honesty and thoroughness help us provide you with the most effective and safe treatment options. Thank you for your cooperation and trust in our services.

0%




If yes, please provide details:



If yes, please list the medications:


If yes, please provide the name and dosage:


If yes, please describe:


If yes, please describe:



You will read the patient information leaflet supplied with your medication
You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
The treatment is solely for your own use
You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.

If yes, please describe:




Please take the time to carefully read the Agreement and Consent statements during our online consultation process. Understanding these statements is essential for your safety and for ensuring that you are fully informed about the treatment you will receive. The Agreement and Consent sections outline important information about the risks, benefits, and responsibilities associated with your medication. By reading and agreeing to these terms, you help us ensure that you are aware of and comfortable with the treatment plan. Your informed consent is crucial for providing you with the best possible care. Thank you for your cooperation and trust in our services.

0%

I have been informed about the potential side effects and interactions of the prescribed medication for UTIs.


I agree to consult with my healthcare provider before starting any new medication. 

I understand that the information provided in this assessment will be reviewed by a licensed pharmacist before my order is processed. 


I consent to my personal and medical information being used to assess my suitability for the prescribed medication.

I understand that my information will be kept confidential and used solely for the purpose of this assessment. 


I confirm that the information provided in this assessment is accurate and complete to the best of my knowledge.

I understand that providing false information may result in my order being cancelled and may have health implications.