Assessment

Are you suffering from Jet Lag?

Please provide more information.

Are you allergic to Melatonin? Melatonin is a hormone used in controlling sleep patterns.

Are you aware that the Melatonin can increase the drowsy effects of other medication you may be taking?

Please confirm which country or countries you are travelling to, or from.

Have you ever been diagnosed with any of the following?

• Liver or Kidney condition,
• Epilepsy,
• An autoimmune condition (e.g. Rheumatoid Arthritis, Lupus)

Are you taking any anti-depressants (e.g. Fluvoxamine)?

Please give more details below

Are you currently taking any prescription-only medicines, alternative medicines or recreational drugs?

Please give more details below

Do you have any known allergies?

Please give more details below

Are you pregnant or planning to become pregnant or breastfeeding?

Please enter your date of birth

We strongly advise that you inform your GP of any medication you receive.

Would you like us to inform your GP of medication you receive from Rightdose?

Please enter your:

• Full Name
• Date of Birth
• Your registered home address with your GP

Please enter your:

• GP Surgery Name
• GP Surgery Address
• GP Surgery Email
• GP Surgery Contact Number

I confirm:

• I am over 18 years old
• The medicine ordered is for my sole use only
• I take responsibility to inform my own regular doctor of the online assessment or any changes in my circumstances
• I will read the patient information leaflet supplied with the medicine specifically the side effects and dosages
• I have answered all the questions truthfully
• I agree to the Rightdose online pharmacy privacy policy and terms and conditions