Direct Meds UK

About You

Are you aged between 18 and 75 and suffering from temporary sleep difficulties?

Yes No

This question is required.

Medication

Are you taking any of the following:

Antihistamines (including those used on your skin and in cold and cough medicines) Tricyclic antidepressants (TCAs) (such as amitriptyline, imipramine, clomipramine, nortriptyline, lofepramine, doxepin and dosulepin) MAOI inhibitors (phenelzine, tranylcypromine, isocarboxazid) Atropine Metoprolol Venlafaxine

Yes No

This question is required.

Agreement

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.

Do you understand that insomnia may be a symptom of a serious underlying medical illness and that if sleeplessness persists continuously for more than 2 weeks, you should speak to your GP?

Yes No

This question is required.

Health

Are you breast feeding, pregnant or planning pregnancy?

Yes No

This question is required.

Are you allergic / hypersensitive to Nytol (Diphenhydramine Hydrochloride)?

Yes No

This question is required.

Do you have any of the following:

Lung problems, such as asthma or COPD Narrow-angle Glaucoma Stomach ulcer, or a blockage in the stomach or gut Problems peeing or emptying the bladder Myasthenia gravis, epilepsy or seizure disorders Kidney or liver problems Galactose intolerance, Lapp Lactase deficiency or glucose-galactose malabsorption

Yes No

This question is required.

Are you aged between 18 and 75 and suffering from temporary sleep difficulties?

Are you taking any of the following:

Do you agree to the following?

Do you understand that insomnia may be a symptom of a serious underlying medical illness and that if sleeplessness persists continuously for more than 2 weeks, you should speak to your GP?

Are you breast feeding, pregnant or planning pregnancy?

Are you allergic / hypersensitive to Nytol (Diphenhydramine Hydrochloride)?

Do you have any of the following:

Confidential & Secure

Need help?

Treatments

Service

Weight Loss

Sexual Performance

Sexual Health

STIs

Pain Relief

Hair, Skin and Nails

Asthma and Allergies

Digestive Health

Sleep - Consultation

Answer quick questions to check your eligibility

Are you aged between 18 and 75 and suffering from temporary sleep difficulties?

Are you taking any of the following:

Do you agree to the following?

Do you understand that insomnia may be a symptom of a serious underlying medical illness and that if sleeplessness persists continuously for more than 2 weeks, you should speak to your GP?

Are you breast feeding, pregnant or planning pregnancy?

Are you allergic / hypersensitive to Nytol (Diphenhydramine Hydrochloride)?

Do you have any of the following:

Confidential & Secure

Need help?

Treatments

Service