Thrush Treatment Consultation

Personal Information

Please provide your details accurately

Name *

First

Last

Date of birth? *

DD

MM

YYYY

Phone number? *

Address? *

Email *

What is your birth sex? *

Male Female

Do you have symptoms of thrush that affect other areas of the body, e.g. the mouth? *

Yes, I Do No, I Do Not

Do you have any urinary symptoms like burning in passing urine or increased frequency or severe lower abdominal pain since last 48 hours? *

Yes, I DO No, I Do Not

Do you have any Foul smelling greenish discharge from your vagina or penis? *

Yes, I Do No, I Do Not

Have you noticed any rash or blisters on your vagina or penis? *

Yes, I Do No, I Do Not

Medical History

Please provide details about your medical history

Have you been tested for STI (sexually transmitted diseases) in the last year. If yes please specify the result. *

Yes, Please specify No, I Haven't

Please specify

Do you have any relevant medical or surgical history that the doctor should be aware of?

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

Final Declarations

Please provide the remaining information

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

Yes, I AM No, I AM NOT

Please specify

Understanding and Honesty Declaration * I understand the above mentioned questions and I have answered them truthfully and to the best of my knowledge.

Personal Use Confirmation * I am confirming that the treatment prescribed above will be for my personal use.

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

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Complete your consultation payment

Consultation Summary

Thrush Treatment Consultation €25.00

Total €25.00

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Thrush Treatment

Personal Information

Treatment & Symptoms

Medical History

Final Declarations

Checkout

Consultation Summary

Secure Payment