Our doctors would now like to check your suitability for this product

Important

This questionnaire forms the basis of your online consultation. Please be honest and if you are unsure about any of your answers, please verify the information with your GP before using the service:

I am 18 years old or above.
I am using this service on my own behalf and of my own free will. Any treatment or advice is for my sole use only.

I confirm the above statements are true

Please note the following important points:

Before completing this questionnarie, it is essential that you have looked at the TravelHealthPro website to see which malaria pills are recommended for where you are going.

Do not use this service if you have a condition that suppresses your immune system- you should see your GP.

Avoid insect bites as well as taking anti-malarial tablets while abroad. No tablet is 100% effective.

See a doctor if you get a high fever within one year of being in a malarial area, as you will need testing for malaria.

Do not take this if you are pregnant or breast feeding.

Please note the following important points:

Before completing this questionnarie, it is essential that you have looked at the TravelHealthPro website to see which malaria pills are recommended for where you are going.

Do not use this service if you have a condition that suppresses your immune system- you should see your GP.

Avoid insect bites as well as taking anti-malarial tablets while abroad. No tablet is 100% effective.

See a doctor if you get a high fever within one year of being in a malarial area, as you will need testing for malaria.

Do not take this if you are pregnant or breast feeding.

Please confirm that you understand this

Medicines

Current and recent use of medicines

Are you taking any prescription-only medicines, over-the-counter medicines, alternative medicines or recreational drugs?

Yes

Allergies

Are you allergic to any of the following?
Please select all that apply.

Penicillin

Grass, pollen, trees, plants (Hay fever)

House dust

Animals (Dogs, cats, horses etc)

Nuts

Do you have any other known allergies?

Yes

Consent

Effectiveness of malaria pills

I understand that the malaria pill I have requested can not guarantee protection against malaria.

I understand that I need to protect myself from mosquito bites even when taking this malaria pill.

I understand the importance of completing the full course of malaria pills.

Travel vaccinations

I understand that I must investigate the need for travel vaccinations, in addition to the malaria pills I am requesting.

Informed consent

I have responded honestly and provided complete and accurate information that reflects my up to date medical history and information, so that the doctor can safely assess and advise me.
I fully understand all the questions and information provided. If I am unsure about any aspect of the service I will contact the Online Doctor before proceeding.
I understand the side effects, effectiveness and alternatives to the treatment I am requesting.
I understand this consultation will form part of my Online Doctor medical record and will be kept in line with the relevant retention period.
I have read, understand and agree to the latest terms and conditions and privacy policy.

I have responded honestly and provided complete and accurate information that reflects my up to date medical history and information, so that the doctor can safely assess and advise me.
I fully understand all the questions and information provided. If I am unsure about any aspect of the service I will contact Lloyds Online Doctor before proceeding.
I understand the side effects, effectiveness and alternatives to the treatment I am requesting.
I understand this consultation will form part of my Online Doctor medical record and will be kept in line with the relevant retention period.
I have read, understand and agree to the latest terms and conditions and privacy policy.

I have responded honestly and provided complete and accurate information that reflects my up to date medical history and information, so that the doctor can safely assess and advise me.
I fully understand all the questions and information provided. If I am unsure about any aspect of the service I will contact the Online Doctor before proceeding.
I understand the side effects, effectiveness and alternatives to the treatment I am requesting.
I understand this consultation will form part of my Online Doctor medical record and will be kept in line with the relevant retention period.
I have read, understand and agree to the latest terms and conditions and privacy policy.