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Acid Reflux Questions

About you and your symptoms

Are you experiencing acid reflux at least twice a week? Symptoms include:


  • Heartburn - a burning feeling in the chest just behind the breastbone that occurs after eating and lasts a few minutes to several hours

  • Chest pain, especially after bending over, lying down or eating

  • Burning in the throat, or hot, sour, acidic or salty-tasting fluid at the back of the throat

  • Feeling of food "sticking" in the middle of the chest or throat

Are you experiencing any of the following?


  • difficulty swallowing
  • unintentional weight loss
  • abdominal swelling
  • persistent vomiting
  • severe/persistent diarrhoea
  • vomiting blood
  • blood in your stools or black, tarry stools
  • have iron deficiency anaemia
  • severe liver problems

Do you have an allergy (hypersensitivity) to medicines containing proton pump inhibitors


 (e.g.omeprazole, pantoprazole, lansoprazole, rabeprazole, esomeprazole)?

Are you breast feeding or pregnant or possibly pregnant?


Do you have any of the following conditions:


  • Osteoporosis
  • Liver problems
  • Gastric cancer
  • Hypomagnesaemia (low magnesium in the blood)

Do you or have you suffered from any heart problems stroke, angina or any other heart related problems ?


Are you taking any medication that has been prescribed by your Gp/Doctor or Hospital ?


Do you give consent for us to contact you GP if required? (we need this to process any order for medication)


Agreements

Have you ever developed a ring-shaped or plaque-shaped rash after sunlight exposure, at a time you have been actively taking a proton pump inhibitor?


Do you understand that healthy eating, reduced alcohol consumption, a healthy body weight and smoking cessation are advisable?


Do you understand that acid reflux treatment supplied through this service can only be used for the short-treatment of gastroesophageal reflux disease (GORD) also known as heartburn/acid indigestion for a maximum of 28 days?


Do you agree to the following statements?


  • You must read the patient information leaflet supplied with your medication
  • You must contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • The treatment is solely for your own use only.
  • You have answered all the questions in this short medical assessment accurately and truthfully to the best of your knowledge. You understand our doctor take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.
all of our tests and treatments are price competative

You need to complete our short medical questionnaire so we can ensure the treatment you have selected is safe for you to use

all of our tests and treatments are price competative

Need Help?

If you need help with this medical questionnnaire call us on 07549286701

 
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Quality products

all of our tests and treatments are price competative

Affordable prices

all of our pharmacies and and treatments purchased are from well known and trusted UK pharmacies

UK pharmacy

all of our tests and any other products purchased will be dispatched for a next day service

Express next day delivery

If you have any further questions about any of our products please feel free to contact us and we will do our best to help you.
Once you have your prescription we will be able to process your order through our trusted UK Pharmacy.