• Important
  • Your migraines
  • Your 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.


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.

What is your sex?

What is your date of birth?

Who diagnosed your headaches as migraines?

Have you ever been prescribed Vydura (Rimegepant) before?

When was your first ever migraine?

How many migraines have you had in your life?

On average, on how many days do you have any headache per month?

Worsening migraines need a more detailed assessment by your GP or specialist to make sure there isn’t another serious cause for your headaches, so you can get the best treatment to suit your needs.

When you have a migraine, do you get any of the following symptoms? Please tick all that apply:


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

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

Have you ever been diagnosed with a severe kidney or liver condition?

Do you currently have a fever?

Do you have a new, undiagnosed rash?

Are you pregnant or breast feeding?


Allergies

Do you have any 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.


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