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07425 899611

Chlamydia Consultation

In the UK, Chlamydia is one of the most common sexually transmitted infections. It is particularly common in sexually active teenagers and young adults, and is passed through sex without a condom. Most people with chlamydia do not know they have it and do not notice any symptoms, and left untreated, chlamydia can cause serious complications.

1. About your Health

To help us understand that this treatment is the right option for you, please answer the following questions.

0%

Please state your gender

This refers to your biological gender

Male

Female

What is your date of birth?

Use the calendar to select your date of birth.

Please add your height (in cms)

Your height is important for the prescribers decision.

Please add your current weight (in kgs)

Please make sure to add your current weight. This may affect the prescriber's decision.

Do you have any recent or past medical history of note?

If so, please provide more information

Yes

No

Do you suffer from any allergies?

If so, please provide more information

Yes

No

Do you currently take any medication whatsoever?

Please list all your current prescription medication including any medication you buy over the counter.

Yes

No

Is there a history of medical disorder's within your family?

If so, please provide more information

Yes

No

Are there any other health/medical details you feel we should know?

If so, please provide more information

Yes

No

2. About your Condition

To help us understand that this treatment is the right option for you, please answer the following questions.

0%

Is this a repeat prescription?

Yes

No

Have you or a sexual partner of yours had a positive chlamydia test?

Yes

No

Do you have any of the following?

Mucous from the back passage
Blood coming from the penis
Bad smelling vaginal mucous
Vaginal bleeding not due to your period?
Severe pelvic pain and / or a temperature?

Yes

No

Are you pregnant, breastfeeding or planning to become pregnant whilst taking doxycycline?

Yes

No

Do you have any of the following conditions?

Kidney problems
Liver problems
Heart problems
Systemic Lupus Erythematous
Myasthenia Gravis
Alcohol dependency
Benign Intracranial Hypertension

Yes

No

Are you allergic to doxycycline or other tetracycline antibiotics?

Yes

No

Are you taking any of the following medicines?

Acenocoumarol
Acitretin
Alitretinoin
Ciclosporin
Isotretinoin
Lithium
Phenindione
Tretinoin (tablets)
Warfarin

Yes

No

Are you aware you should refrain from sexual contact for 7 days until your treatment has been completed?

Yes

No

Are you aware, after treatment, it may take up to 14 days for symptoms to go? (You may have no symptoms at all)

Yes

No

Are you aware doxycycline does not treat all sexually transmitted disease?

Yes

No

Are you aware, where possible, sexual partner(s) should be informed of your need for chlamydia treatment?

Yes

No

Are you aware that guidelines recommend a repeat chlamydia test after 3 months if you are under 25 years old?

Yes

No

Is there anything else which you feel we should know about prior to you taking this medication?

Yes

No

3. The Agreement and Consent

Please answer the following questions to help us confirm that you'll follow the guidelines for this medicine.

0%

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

I agree to the Terms and Conditions and I confirm that I am over 18
Terms and Conditions

Yes

No

About Us

Profarma Direct is a cutting-edge online pharmacy that specialises in lifestyle medicine and personalised prescriptions.

Marsh House Lane, Darwen, Lancashire, BB3 3JB, United Kingdom
07425 899611
For Sales & Orders:
info@profarmadirect.com
For General Enquiry:
info@profarmadirect.com

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How to check GPhC Registration

You can check our pharmacy details and registration status here. You can also see details of any Fitness to Practise decisions relating to a registrant.

GPhC Registration Number:

2076639

GPhC Registered Owner:

Profarma Direct Ltd

Superintendent Pharmacist:

Zakaria Jalgaonkar

GPhC Pharmacy Details:

Marsh House Lane, Darwen, Lancashire, BB3 3JB, United Kingdom

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