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 [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
How do you know you have a fungal nail infection?
Please select the areas that are affected:
How many fingernails/toenails are affected?
(If five or more nails are affected, it may indicate that anti-fungal tablets such as Terbinafine will be more effective than anti-fungal nail lacquer)
What does the affected nail look like?
Please provide a picture of the nail if possible
Do you suffer from any of the following:
Please provide more information
Have you used any anti-fungal nail treatments before?
Please provide details of which treatment you have used and how long it was used for
Are you allergic, hypersensitive or had any severe side effects from this medication?
Please provide more details
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.
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