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07425 899611

Genital Warts Consultation

Genital Warts are a common sexually transmitted infection (STI). They can be passed on by vaginal and anal sex, sharing sex toys and oral sex (this is rare).

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

If you are of child bearing potential, are you using effective contraception?

Yes

No

Have you been diagnosed by your GP or GUM clinic with Genital Warts?

Yes

No

Are you experiencing any of the following?

unintentional weight loss
blood in your urine or stools
pain when urinating
urinary tract infections (UTI)
night sweats
fever
bleeding from the anus or urethra
discharge/ fluid from the wart
discharge from the penis or vagina
swollen lymph nodes
abnormal urine flow
change in the appearance of your warts since they were diagnosed by a medical doctor
warts located internally (inside the urethra, vagina, cervix, rectum or anus)
anal warts
open, sores or wounds, broken skin or ulcers near your warts including broken skin following surgery
bleeding between periods or after sex (women only)
warts on foreskin
you have had your current outbreak for more than 18 months
your warts cover an area larger than 4 cm2

Yes

No

Do you have an allergy (hypersensitivity) to medicines containing imiquimod or podophyllotoxin?

Yes

No

Are you breastfeeding or pregnant or possibly pregnant?

Yes

No

Have you been diagnosed with any of the following?

Liver problems
Kidney problems
Immunodeficiency/ immunocompromising conditions (eg. HIV, autoimmune conditions/ diseases)
Abnormal blood count
You have received an organ transplant
Your warts cover an area larger than 4 cm2
Reduced haematologic reserve
Any serious medical condition which may require immediate hospitalisation

Yes

No

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

If so please list the medications

Yes

No

Are you taking any of the following medications?

Any immunosuppressive medication
Any other treatment for genital warts

Yes

No

Do you understand that it is best practice to maintain genital hygiene and avoid sexual contact whilst on treatment, but if you do have sexual contact, please wear a condom?

Yes

No

Do you understand that you should return to your GP or GUM clinic for an examination of your genital warts if they do not improve after 4 weeks of treatment with podophyllotoxin (Warticon) or 16 weeks of treatment with imiquimod (Aldara)?

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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