• Important
  • Background
  • Health
  • Consent
Our doctors would now like to check your suitability for this product

How did you hear about us?

Before you start, you need to know

I confirm the above statements are true --This service is designed for individuals who have no symptoms. If you have symptoms please attend your local Sexual Health Clinic.
--We strongly recommend that you test for sexually transmitted infections before being treated. You can order a home test kit through our STI testing service or attend your local Sexual Health Clinic.
--If you are requesting medicine for a partner then STOP! Your request will be rejected. Your partner must register and purchase treatment themselves as it could put your partner\'s health at risk to order on their behalf.
--Misuse and overuse of antibiotics can cause antibiotic resistance, so in the future they don’t work. Only order this antibiotic if you have been diagnosed with chlamydia or you have had sex within the last 2 weeks with a partner who has been diagnosed with chlamydia.
--If you think you have been exposed to HIV within the last 72 hours, you should seek URGENT medical advice from your local sexual health clinic, GP or Accident & Emergency, as HIV Post-Exposure Prophylaxis may be recommended.
--If you’ve been sexually assaulted, we recommend that you access specialist services that can provide treatment or support.

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.

Reason for treatment

What is your sex?

What is your date of birth?

I seek treatment for the following reason:


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.

Are you pregnant or breastfeeding?


Symptoms

Do you have any symptoms that you think are due to chlamydia?

Are you allergic to any of these antibiotics?

Are you allergic to soya or peanuts?

Do you have any of the following? Please tick all that apply.

Do you take any prescribed medication?


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 sexual partners

I confirm the above statements are true Ideally all your sexual partners in the last six months should be traced and told that they need screening for chlamydia. We can do this for you anonymously by sending a text message. Would you like us to do this for you?


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 Crest Pharmacy Online Doctor before proceeding.
--I understand the side effects, effectiveness and alternatives to the treatment I am requesting.
--I understand the importance of notifying my GP about medicines and advice I may receive from this service so they can continue to provide safe medical care.
--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
--If I have further questions in relation to my sexual health or wellbeing, I will contact my GP or healthcare professional.


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