1
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?

NoYes

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?

NoYes

Sorry we can't offer you this treatment, please contact your GP.

Have you been diagnosed with any medical conditions?

NoYes

Please provide more detail.

Are you currently taking any medication? This includes prescription-only, over-the-counter and homeopathic medicines.

NoYes

Please provide more detail.

Do you suffer from any allergies?

NoYes

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?

NoYes

Please provide more detail.

2
Medical Questions

Have your genital warts been diagnosed by a doctor or sexual health clinic?

Either on this occasion or on a previous outbreak.

If "No" - Please confirm that you have compared your condition to the follwoing resources:

If you have not been diagnosed by a healthcare professional, we would suggest that you send an email and attach a photo of your condition for diagnosis via our medical team.

NoYes

Please provide more details

How long have you had this outbreak of warts for?

Are you currently using any genital wart treatment?

NoYes

If "Yes", please tell us what treatment(s) you are using.

Do any of the following apply:

You have had your current outbreak for more thatn 18 months
You have tried treating this outbreak of warts and it has not been effective

NoYes

If "Yes", please give as much detail as possible.

Are you experiencing any of the following symptoms:

A change in the flow of urine
Bleeding from the urethra or the anus
Pain when urinating
Discharge from the penis or vagina
Warts located internally (inside the urethra, vagina or anus)
Bleeding between periods or after sex (women only)
Open sores or wounds near your warts

NoYes

If "Yes", please list all symptoms that apply to you.

Have you had a recent STI screening?

NoYes

We recommend that you have an STI test if you have not had one recently.

3
Consent

Would you like us to notify your GP of the treatment you chose to order today?

NoYes

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:

You understand the prescriber will take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
You are aware you will be subject to a soft check to validate your identity via Experian
You will read the Patient Information Leaflet supplied with your medication
You agree to Cloud Pharmacy terms and conditions and privacy policy.
The treatment is solely for your own use
You have answered all the above questions accurately and truthfully
You will inform your GP of this purchase if appropriate

NoYes

Sorry we can't offer you this treatment, please contact your GP.

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.

Assessment

Trust Pilot

Medical Questions

2
Medical Questions

3
Consent

Confirm Aldara 5% Cream treatment selection

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Assessment

Trust Pilot

Medical Questions

2Medical Questions

3Consent

Confirm Aldara 5% Cream treatment selection

2
Medical Questions

3
Consent