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MEDICAL ASSESSMENT

Q No.QuestionAnswer
1

Are you pregnant or breastfeeding?

2

Have you been diagnosed with thrush before which has gone with simple treatment?

3

Do you have any problems with your liver or kidneys?

4

Have you had more than two thrush infections in the last six months?

5

Are you allergic to the ingredients of the treatment you wish to use?

  • Single dose oral tablets contain fluconazole
  • Creams/pessaries contain clotrimazole / miconazole / anti-fungal cream
6

Have you or your partner had exposure to sexually transmitted disease?

7

Do you have any of the following?

MEN:

  • Sores, blisters or ulcers on or around the penis
  • Discharge (mucous like substance) leaking from the end of the penis

WOMEN:

  • Sores, blisters or ulcers in the vaginal area
  • Irregular or unexplained vaginal bleeding
8

Are you taking the antihistamine terfenadine or the prescription medicine cisapride?

9

Have you been diagnosed with liver or kidney disease?

Not including very minor illness that has completely resolved or occasional urinary infections.

10

Are you aware that there are other things you can do to ease your symptoms in addition to medication?

Things you can do to ease and prevent thrush include:

  • Avoiding scented products to wash your genitals and sticking to water and emollient
  • Making sure the affected area is completely dry before putting on underwear
  • Wearing cotton underwear instead of synthetic fabrics, as cotton is more breathable whereas synthetic fabrics encourage moisture
  • Avoiding sex until your symptoms have cleared
  • Taking showers instead of baths
  • Avoiding douching your vagina (females)
11

Do you suffer from any chronic disease likely to reduce your immunity?

12

Are you aware thrush symptoms should go within 10 days of starting treatment?

Thrush symptoms should go within 10 days of starting treatment.

13

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.
14

What is the name of your GP surgery and do you consent to us contacting them about your treatment?

15

Do you consent to us accessing your GP records? This is advised so we can clinically assess suitability.

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