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

The use of Circadin (Melatonin) for jet lag is "off label". This means its use for jet lag hasn't been specifically tested by the manufacturer so there is limited study of the effectiveness and unexpected side effects. However, it has been used for jet lag in clinical practice for many years. As it is being used in a different way to that described by the licence, it is important to tell us if you experience any side effects. The patient information leaflet that accompanies the medicine may also differ slightly to the advice we give you.

If you select delivery, parcels may be posted through your letterbox. Once the parcel has been delivered through the letterbox, Online Doctor is not liable for any loss, theft, or damage to the parcel. If you don’t want your order to be posted through your letterbox, you can choose pharmacy collection.

I understand

Trip

Travel destination

Country you are travelling to

What is the usual time difference between the UK and the country you are flying to?

Consent

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 confirm the above statements are true

Important

Trip

Travel destination

Medicines

Current and recent use of medicines

Allergies

Health

Your medical history

Pregnancy and breastfeeding

Consent

Informed consent

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