Treatment Questions | Pharma Aesthetics

Answer medical questions to order

Have you read the anti-malaria tablets medical information?

Yes No

For my area of travel, Fitfortravel recommends the following

Yes No

(tick ALL the recommended medication from the list below): Atovaquone/proguanil (Malarone) Mefloquine (Lariam) Doxycycline

Are you allergic to:

Yes No

Proguanil (Paludrine) Mefloquine (Lariam) Doxycycline or Tetracycline antibiotics Atovaquone/proguanil (Malarone) Quinine or quinidine

Are you pregnant or do you intend to become pregnant during your trip or within 3 months afterwards?

Yes No

Will you be breastfeeding whilst taking antimalarial medication?

Yes No

Have you been diagnosed with liver disease?

Yes No

Have you been diagnosed with kidney disease?

Yes No

Not including occasional urinary infection.

Do you have epilepsy or seizures?

Yes No

Are you aware that no malaria tablet provides 100% protection?

Yes No

See "Avoiding mosquito bites" advice in medical information.

Are you aware that if you get a fever between 1 week and 1 year after exposure you should seek medical attention and tell the doctor the background?

Yes No

Do you need malaria tablets only for yourself?

Yes No

Do all the following apply to you?

Yes No

I will read the patient information leaflet supplied with my tablets The tablets are for my own use - I am ordering only for myself. You MUST NOT order for other people. 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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Antimalarials

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