Direct Meds UK

About You

Are you aged between 18 and 65?

Yes No

This question is required.

Have you been diagnosed by your GP, nurse or pharmacist with cold sores (herpes labialis)?

Yes No

This question is required.

Medication

Are you currently taking any of the following medication (including over the counter, prescription or recreational drugs)?

cimetidine (used to treat peptic ulcers) probenecid (used to treat gout) raloxifen medicines that suppress your immune system (e.g. mycophenolate mofetil; ciclosporin; tacrolimus; methotrexate) theophylline and aminophylline (used in asthma and other breathing problems) zidovudine (used in HIV infection) any medicine which affects the kidneys, including aminoglycosides, organoplatinum compounds, iodinated contrast media, pentamidine, foscarnet

Yes No

This question is required.

Agreement

Do you understand that outbreak treatment should be initiated at the earliest symptom of a cold sore eg tingling, itching or burning sensation?

Yes No

This question is required.

Do you understand that if your symptoms are getting worse and the sores have not healed after 10 days you must see your doctor?

Yes No

This question is required.

Do you agree to the following?

You will read the patient information leaflet supplied with your medication You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment. The treatment is solely for your own use You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.

Yes No

This question is required.

Health

Do you have an allergy (hypersensitivity) to medicines containing Aciclovir or Valciclovir or Famacilovir or Penciclovir?

Yes No

This question is required.

Are you pregnant, breast feeding or possibly pregnant?

Yes No

This question is required.

Have you been diagnosed with any of the following conditions?

Liver problems Kidney problems Any condition affecting the immune system i.e. cancer, HIV etc Nervous system abnormalities Electrolyte abnormalities Any serious medical condition which may require immediate hospitalisation

Yes No

This question is required.

Symptoms

Do you have any of the following symptoms:

Mouth ulcers /lumps lasting more than 3 weeks Painful red and white patches on the inside of the mouth Fluid filled blisters/crusts on the lips

Yes No

This question is required.

Are you aged between 18 and 65?

Have you been diagnosed by your GP, nurse or pharmacist with cold sores (herpes labialis)?

Are you currently taking any of the following medication (including over the counter, prescription or recreational drugs)?

Do you understand that outbreak treatment should be initiated at the earliest symptom of a cold sore eg tingling, itching or burning sensation?

Do you understand that if your symptoms are getting worse and the sores have not healed after 10 days you must see your doctor?

Do you agree to the following?

Do you have an allergy (hypersensitivity) to medicines containing Aciclovir or Valciclovir or Famacilovir or Penciclovir?

Are you pregnant, breast feeding or possibly pregnant?

Have you been diagnosed with any of the following conditions?

Do you have any of the following symptoms:

Confidential & Secure

Need help?

Treatments

Service

Weight Loss

Sexual Performance

Sexual Health

STIs

Pain Relief

Hair, Skin and Nails

Asthma and Allergies

Digestive Health

Cold Sores - Consultation

Answer quick questions to check your eligibility

Are you aged between 18 and 65?

Have you been diagnosed by your GP, nurse or pharmacist with cold sores (herpes labialis)?

Are you currently taking any of the following medication (including over the counter, prescription or recreational drugs)?

Do you understand that outbreak treatment should be initiated at the earliest symptom of a cold sore eg tingling, itching or burning sensation?

Do you understand that if your symptoms are getting worse and the sores have not healed after 10 days you must see your doctor?

Do you agree to the following?

Do you have an allergy (hypersensitivity) to medicines containing Aciclovir or Valciclovir or Famacilovir or Penciclovir?

Are you pregnant, breast feeding or possibly pregnant?

Have you been diagnosed with any of the following conditions?

Do you have any of the following symptoms:

Confidential & Secure

Need help?

Treatments

Service