Consultation - The Care Pharmacy

Who is this treatment for?

Please note this treatment is only suitable for the person completing the consultation

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Myself

Someone else

By clicking start now you agree to our Privacy Policy and confirm that you are over 18 years of age.

Why are you requesting treatment today?

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Seasonal allergy symptoms (hay fever)

Allergy symptoms all year round (for example dust mites or pet allergies)

Symptoms have worsened recently

Other reason

What action have you taken so far to manage your symptoms?

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Which symptoms are you currently experiencing?

Select all that apply

Have you noticed any bleeding from your nose?

If bleeding lasts more than two to four weeks, you should see your GP

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No bleeding

Yes, occasional small amounts that stop quickly

Yes, ongoing bleeding lasting more than two weeks

Are your current symptoms similar to your usual allergy symptoms?

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Yes, they are the same

Yes, but more severe than usual

No, they are different

Do you have any of the following nasal issues?

Select all that apply

Heavy or frequent nosebleeds

Infection or sores in the nose that have not healed

None of the above

Have you had a nose injury in the last three months?

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Yes

Have you ever had surgery on your nose?

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Yes

Do you have, or have you ever had, any of the following medical conditions?

Are you currently being treated for tuberculosis (TB) in your lungs?

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Yes

Women only: are you currently pregnant or breastfeeding?

If you are male select "Not Applicable"

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Not applicable

Pregnant

Breast feeding

Neither

Are you currently taking any medication or have you recently finished a course of medication?

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Yes

Do you have any known allergies?

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No known allergies

Yes, to medicines

Yes, to food

Yes, to environmental allergens

Is there anything else about your health that you think the prescriber should know?

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Yes

The Agreement and Consent

Do you agree to the following?

I declare that I have answered all questions truthfully and to the best of my knowledge.
I will read the Patient Information Leaflet before taking any prescribed medication.
I will contact The Care Pharmacy and inform my GP if I experience any side effects, start new medication, or if my medical conditions change during treatment.
I understand that prescribers take my answers in good faith and base prescribing decisions accordingly, and that incorrect information can be hazardous to my health.
I understand that this questionnaire forms part of a request to the prescriber, and that the final decision to prescribe rests with the prescriber.
I consent to this consultation being used to assess my suitability for treatment.
I understand that my medication may require cold storage and careful handling.
I agree to the stated delivery terms and understand that medicines will be dispatched in line with storage and safety requirements.
I agree to be contacted for a follow-up video call if required.
I understand that I will only be charged if my consultation is approved and a prescription is issued.
I understand that the clinician may access my NHS Summary Care Record to support safe prescribing, including information about my medications, allergies, and adverse reactions.