Ureaplasma And Mycoplasma consultation

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Please describe the symptoms you want to use this treatment for?

Do any of the following apply to you?
Swollen glands
high temperature
or feeling unwell.

Yes

This question is required and must be answered.

Have you or any sexual partners had a recent positive test for a sexually transmitted Infection?

Yes

This question is required and must be answered.

Have you had a test for Ureaplasma or Mycoplasma and what were the results?

Please confirm that you should refrain from unprotected intercourse until your STI is fully treated.

Yes, I confirm

This question is required and must be answered.

Please confirm that if you have any remaining symptoms after taking this medication you will get retested and retreated if needed.

Yes, I confirm

This question is required and must be answered.

I agree to contact any recent sexual partners and advise them to have testing and treatment.

Yes, I confirm

This question is required and must be answered.

Do you take any medication, or have any medical conditions?

Yes

This question is required and must be answered.

Do you have any disabilities or special needs that we should be aware of, in order to provide you with the best possible care?

For Example: ADHD, ASD or Learning Difficulties. This will help our clinicians and pharmacy team to allow you access all our services safely.

Yes

This question is required and must be answered.

Do you have any known allergies? E.g. Penicillin, egg protein or peanuts or an allergy to the ingredients in some medication eg lactose?

Yes

This question is required and must be answered.

Do you have any liver or kidney problems including reduced kidney function or chronic liver disease?

Yes

This question is required and must be answered.

Are you breastfeeding or pregnant or planning to be pregnant?

Yes

This question is required and must be answered.

Do you give us permission to inform your NHS surgery, about this prescription?

Yes

It is important to tell your doctor of any medication you have been prescribed for them to be able to treat you appropriately, safely and to avoid any drug interactions.

I am over 18 and this is for my sole use. I understand this is a non emergency service. I confirm I have answered all questions accurately and understand the doctor will use this information to prescribe safely for me.

Yes, I confirm

This question is required and must be answered.

By providing us with your details you confirm that you have read, understood and agreed to the legal terms and you consent to the sharing of your data to use our service.
I consent to treatment and an identity check
I give consent for the pharmacist to access and store relevant information from my NHS summary care record which may be needed to safely prescribe.
I agree to read the Patient Information Leaflet supplied with the medication.

Yes, I confirm

This question is required and must be answered.

Online Consultation for Ureaplasma and Mycoplasma

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