Consultation

British ChemistConsultation

Q No.	Question	Answer
1	Are you pregnant or breastfeeding or likely to be at the time of taking aciclovir? You must answer this question. You must answer this question. Please write your explanation in the box below	YesNo
2	Do you have any problems with your liver or kidneys? Please check with your doctor, if you are not sure Renal impairment is part of the ageing process and people over 65 should check with their GP. You must answer this question. You must answer this question. Please write your explanation in the box below	YesNo
3	Have you been diagnosed with genital herpes? People with genital sores and other symptoms of sexually transmitted disease must have had a full medical assessment before obtaining treatment online. New and changing symptoms need investigation. Aciclovir only treats herpes virus infections, NOT other sexually transmitted diseases. You must answer this question. You must answer this question. Please write your explanation in the box below	YesNo
4	Have you been diagnosed with reduced immunity from any cause? For instance you have: Had a bone marrow transplant or low white blood cell count. Been diagnosed with a neurological abnormality or any condition leading to permanently low oxygen levels. HIV or AIDS Note: most people who are troubled with genital herpes have normal immune systems. You must answer this question. You must answer this question. Please write your explanation in the box below	YesNo
5	Are you taking any of the following medications? Cimetidine (used to treat stomach ulcers). Probenecid (used to treat gout). Mycophenolate mofetil (used to stop your body rejecting transplanted organ). Ciclosporin (an immunosuppressant drug). Your doctor may monitor your kidney function. Theophylline (used in asthma and other breathing problems). Zidovudine (used in HIV infection). You must answer this question. You must answer this question. Please write your explanation in the box below	YesNo
6	Do you know that: You should avoid having sex until all of your symptoms have disappeared. Genital herpes is a highly contagious condition that can be passed to sexual partners if it isn’t treated. You should use a condom even after your symptoms have cleared to avoid the spread of the virus You should see your doctor if you’re experiencing frequent outbreaks of genital herpes, or if they’re getting worse each time even with treatment You must answer this question. You must answer this question. Please write your explanation in the box below	YesNo
7	Are you aware that aciclovir works best to treat an attack when taken as soon as symptoms of sores start? It is best to start treatment in the first 24-48 hours – it is reasonable to keep supplies at home in reserve. The first symptoms are usually pain and tingling at the site of the sore. Herpes sores always break-out in the same places – sores in new places need investigation. You must answer this question. You must answer this question. Please write your explanation in the box below	YesNo
8	Are you aware genital herpes can be passed on to partners, particularly when sores are active and open? Condoms provide significant protection from infection, but not 100% protection. You must answer this question. You must answer this question. Please write your explanation in the box below	YesNo
9	Are you aware treatment dose is one aciclovir 400mg tablet three times daily for five days or suppression dose is 400mg twice daily for up to 12 months? This is the prescribed dose written on the label affixed to the packet, and differs from the patient information leaflet supplied with the tablets. Please follow the instruction on the label affixed to the packet supplied. You must answer this question. You must answer this question. Please write your explanation in the box below	YesNo
10	Do you have any further medical information or questions? Is there anything you do not understand or do you need further help? Please note if you have questions at any stage you can email us, call us or use our live chat feature. You must answer this question. You must answer this question. Please write your explanation in the box below	YesNo
11	Do you agree to the following? 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 are over the age of 18 and you have entered your own information for our identity verification checks. You have answered all the above questions accurately and truthfully. You understand our doctors take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health. You will inform your own GP of this purchase if appropriate. You have read our privacy policy, cookie policy, patient agreement, data sharing agreement and Terms & Conditions. You must answer this question. You must answer this question. Please write your explanation in the box below	YesNo
12	What is the name of your GP surgery and do you consent to us contacting them about your treatment? You must answer this question. You must answer this question. Please write your explanation in the box below
13	Do you consent to us accessing your GP records? This is advised so we can clinically assess suitability. You must answer this question. You must answer this question. Please write your explanation in the box below	YesNo

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