Consultation

Are you pregnant, breastfeeding or trying to become pregnant?

Have you been diagnosed with blood pressure?

What is your latest Blood Pressure reading?

Have you used the medicine you are going to request before (Name of medication and dose)?

Have you been diagnosed with any of the following conditions?

• Heart block or heart failure
• Breathing/lung problems (such as asthma or COPD)
• Phaeochromocytoma (tumour of adrenal gland)
• Peripheral arterial disease (narrowing of blood vessels in the arms or legs)
• Renal artery stenosis (narrowing of the blood vessels leading to the kidneys)

Can you confirm that the main reason you take this medication is to control your blood pressure?

Are you allergic to any medicines or other substances?

Do you have any liver or kidney problems?

Have you currently or have you ever been diagnosed with any mental health conditions?

Are you attending regular (at least yearly) blood tests at your GP surgery to monitor your blood pressure medication (e.g. to check your kidney function)?

Have you ever had a heart condition or stroke?

Is your medication currently causing you any side effects

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

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

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