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

Medicines

Current and recent use of medicines

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

Yes

In the last two months have you taken any medicine, including both prescription and non-prescription medicines, other than any medicine you have mentioned above?

Yes

Allergies

Do you have any other known allergies?

Yes

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

Symptoms

Your Symptoms

History

Your medical history

Pregnancy and breastfeeding

Medicines

Current and recent use of medicines

Allergies

Consent

Informed consent

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