Your Health
The information you provide us is treated with absolute confidentiality and will be reviewed by our experienced UK prescribers. We ask the following questions to provide the prescriber with an appropriate level of information to make an informed decision on whether the treatment is suitable or not.
What is your gender?
Please provide more detail.
Do you need help completing this questionnaire?
Please contact us on 020 7157 9759 or [email protected] and we can assist you.
Do you believe that you have the capacity to make decisions about your own healthcare?
Sorry we can't offer you this treatment, please contact your GP.
Have you been diagnosed with any medical conditions?
Are you currently taking any medication? This includes prescription-only, over-the-counter and homeopathic medicines.
Do you suffer from any allergies?
Please provide details including which allergies and what symptoms you experience.
Is there anything else you would like to include to allow our prescriber to prescribe responsibly?
Medical Questions
Have you been diagnosed with hayfever (seasonal allergic rhinitis) by a doctor or nurse previously?
When were you diagnosed
What do you do for a job?
Please select the symptoms that you suffer from.
You can select more than one answer.
Please describe what symptoms you suffer from
Are these symptoms new or have you experienced them long-term?
Have you used treatments for hayfever or allergies before?
Please tell us what treatment you used and if it was effective
Do you experience persistent blood-stained discharge from your nose?
Please provide more information
Have you had a recent nasal/head injury in the past 4 weeks?
Has a doctor/specialist ever told you, you have a deviated septum of the nose?
Have you ever had nasal surgery?
I am aware that sprays such as Beconase, Dymista, Avamys and Flixonase contain steroids and should only be used for short periods of time
Consent
Would you like us to notify your GP of the treatment you chose to order today?
Please provide details.
It is very important that your GP is aware of all the medication you are taking, so that you are receiving the best possible care. You should only select “no” if you are completely sure you do not wish us to tell your GP.
Do you agree to the following:
If treatment is not suitable, you will be fully refunded and signposted to another point of care. The decision about the treatment is for both the patient and the prescriber to consider, however, the final decision will always lie with the prescriber.
We use cookies to give you the best online experience. By using our website you agree to our use of cookies in accordance with our cookie policy.