• Important
  • Symptoms
  • History
  • Medicines
  • Consent
Our doctors would now like to check your suitability for this product

How did you hear about us?

I confirm the above statements are true This questionnaire forms the basis of your online consultation. Please be honest and if you are unsure about any of your answers, please verify the information with your GP before using the service:

--I am 18 years old or above.
--I am using this service on my own behalf and of my own free will. Any treatment or advice is for my sole use only.


We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

About your Symptoms

What is your sex?

What is your date of birth?

Which of the following hay fever symptoms do you experience? Please tick all that apply.

Have you had recurrent nose bleeds, blood stained or green discharge, pain OR discharge from one side of the nose?

Have you ever been prescribed Telfast or Fexofenadine for hay fever?

Have you ever used any other antihistamine tablet for your hayfever?


We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

Your medical history

Other than those already mentioned, do you have any other significant medical conditions, illnesses or past surgical procedures?


Pregnancy and breastfeeding

How do I know if I\'m pregnant?

Are you breastfeeding?


We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

Current and recent use of medicines

Are you taking any prescription-only medicines, over-the-counter medicines, alternative medicines or recreational drugs?

In the last two months have you taken any medicine, including both prescription and non-prescription medicines, other than any medicine you have mentioned above?


Allergies

Do you have any other known allergies?


We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

Informed consent

I confirm the above statements are true --I have responded honestly and provided complete and accurate information that reflects my up to date medical history and information, so that the doctor can safely assess and advise me.
--I fully understand all the questions and information provided. If I am unsure about any aspect of the service I will contact Your Chemist Online Doctor before proceeding.
--I understand the side effects, effectiveness and alternatives to the treatment I am requesting.
--I understand this consultation will form part of my Online Doctor medical record and will be kept in line with the relevant retention period.
--I have read, understand and agree to the latest terms and conditions and privacy policy


0% of questionnaire complete