Assessment

What is your biological sex?

Please enter your date of birth

Are you aware of any allergies you have to any medications or substances?

Please provide more information below.

Do you currently take any prescription medication,alternative medication or recreational drugs?

Please provide more information below.

Are you currently pregnant, breastfeeding or planning to become pregnant?

Please provide more information below.

Do you have any other health conditions or problems?

Please provide more information below.

Have you currently or recently had an STI (Sexually Transmitted Infection)?

Please provide more information below.

Why do you need treatment for Bacterial Vaginosis (BV)?

Please provide further information below

Do you currently have any of the following:

• Abnormal vaginal bleeding
• A coil or IUD (intrauterine device) fitted
• Flu-like symptoms

Is it painful when you urinate?

Is your vaginal discharge thin and watery?

Is your vaginal discharge thick and clumpy?

Is there an unpleasant fishy odour around your vagina?

Have you been diagnosed with Pelvic Inflammatory Disease?

Have you used metronidazole to treat bacterial vaginosis successfully in the past?

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.