Hay Fever Treatment Consultation

Medical History

Please provide your medical information

Do you have past medical history of asthma? *

YES NO

Are you allergic to any medications or any other substance? *

NO If YES I HAVE, please specify:

Are you taking any regular medication? or have you taken any prescription, non prescription, illegal drugs or herbal medication in last 2 months?

NO If YES I AM, please specify

Do you have any past medical history or past surgical history that you want to mentioned to our doctor? *

NO If YES I HAVE, please specify:

Lifestyle & Confirmation

Final step - health information and pharmacy details

Please specify your gender? *

MALE FEMALE

Have your blood pressure been checked recently? *

I CANNOT REMEMBER If TAKEN IN THE LAST 6 MONTHS, please specify BP reading (eg: 120/80 mmHg)

Do you smoke cigarettes? *

Do you drink alcohol? please specify weekly consumption. *

Do you have any past medical or surgical history? If yes please specify below. *

Are you on any regular medication? If yes please specify below. *

Additional notes (if any of the above answers were 'Yes - Please specify'):

Please specify the name of Preferred pharmacy where you want to collect your prescription/medications? *

I understand the above mentioned questioned and I have answered them truthfully and to the best of my knowledge. *

I CONFIRM I DO NOT CONFIRM

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Review your details and complete payment

Consultation Summary

Hay Fever Consultation Fee

GP Review + Prescription

€25.00

Your payment is processed securely via Stripe. We never store your card details. If the prescription is not appropriate for you, a full refund will be issued.

Hay Fever Treatment

Personal Information & Hay Fever History

Medical History

Lifestyle & Confirmation

Checkout

Consultation Summary

Hay Fever Consultation Fee