We will access your consultation upon receipt to determine the outcome
Date Format: MM slash DD slash YYYY
Medicines to treat epilepsy (e.g. phenytoin, carbamazepine)
Antibiotic medicines to treat an infection (e.g. tetracyclines, rifampicin, co-trimoxazole)
Antiviral medicines to treat HIV (e.g. ritonavir, nelfinavir)
Herbal preparations containing St John's Wort (Hypericum perforatum)
Aminoglutethimide, sometimes used in Cushing's syndrome
Ciclosporin (for suppressing the immune system)
Non-steroidal inflammatory drugs (NSAIDs) for treating pain and inflammation
Medicines for high blood pressure
ou will read the patient information leaflet (provided with your medication or by following the relavent link)
The treatment is solely for your own use
All the information you have provided is accurate. You understand our prescribers can only base descions on the information provided and that incorrect information can be detrimental to your health.
We need to ensure that this medicine is suitable for the person it is intended for. Therefore may be required to contact you by phone/video call, If we are unable to speak to you when required your order may be delayed.
You will seek medical advice if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
To provide consent to contact or share information with your GP regarding this prescription if necessary?
I confirm that I give permission for My Pharmacy 365 to inform my doctor of the treatment I have received if the prescriber feels it is clinically necessary