Treatment Questions | Pharma Aesthetics

Answer medical questions to order

Have you read the thrush medical information?

Yes No

Have you been diagnosed with thrush before which has gone with simple treatment?

Yes No

Have you had more than two thrush infections in the last six months?

Yes No

Are you allergic to the ingredients of the treatment you wish to use?

Yes No

Single dose oral tablets contain fluconazole Creams/pessaries contain clotrimazole / miconazole / antifungal cream.

Have you or your partner had exposure to sexually transmitted disease?

Yes No

Do you have any of the following?

Yes No

WOMEN: Sores, blisters or ulcers in the vaginal area Irregular or unexplained vaginal bleeding MEN: Sores, blisters or ulcers on or around the penis Discharge (mucous like substance) leaking from the end of the penis.

Have you been diagnosed with liver or kidney disease?

Yes No

Not including very minor illness that has completely resolved or occasional urinary infections.

Are you pregnant or breastfeeding?

Yes No

Do you suffer from any chronic disease likely to reduce your immunity?

Yes No

Are you aware thrush symptoms should go within 10 days of starting treatment?

Yes No

Thrush symptoms should go within 10 days of starting treatment.

If ordering fluconazole, have you checked that any other medication you take does not have the rare potential of causing heart rhythm problems when taken together?

Yes No

There is a very rare theoretical risk of abnormal heart rhythm if fluconazole is taken at the same time as some other medications - please check this list. If not ordering fluconazole click 'Yes'.

Do you have any further medical information or questions?

Yes No

Is there anything you do not understand or do you need further help?

Do the following apply to you?

Yes No

The medication is for my own use and I will not share with anyone else I will read the patient information leaflet supplied with medication I am over 18 and I agree to identity verification checks I have completed this questionnaire myself and fully understand all the information My responses are honest and accurate, and I understand that this is necessary for a safe medical assessment I agree to the terms & conditions, privacy policy, data sharing policy & consent to cookies

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Genital thrush

Answer medical questions to order

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