• Important
  • Countries
  • Medicines
  • Health
  • 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.

Please confirm that you understand this Please note the following important points:

--Before completing this questionnarie, it is essential that you have looked at the TravelHealthPro website to see which malaria pills are recommended for where you are going.
--Do not use this service if you have a condition that suppresses your immune system- you should see your GP.
--Avoid insect bites as well as taking anti-malarial tablets while abroad. No tablet is 100% effective.
--See a doctor if you get a high fever within one year of being in a malarial area, as you will need testing for malaria.


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.

Countries to be visited

What is your sex?

What is your date of birth?

First country you are visiting

Please tell us which area(s) of this country you will be travelling to

Are you visiting any other countries?

When are you first arriving in a malaria area?


Malaria pills

Have you looked on the TravelHealthPro website to ensure malaria pills are recommend in the countries you have listed above?

Does the TravelHealthPro website recommend the specific malaria pills you are requesting for all the countries you have named above?

If you have previously taken the specific malaria pill you are requesting, did you experience any side-effects?


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?


Allergies

Are you allergic to any of the following? Please select all that apply.

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.

Your general health

Do you weigh less than 40kg (6 stone 3lbs)?

Have you ever been diagnosed with a liver condition?

Have you ever been diagnosed with a kidney condition?

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.

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


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