Have you ever been diagnosed with any of the following?

• Heart problems including an irregular or fast heartbeat or angina
• Epilepsy
• Kidney or liver problems

• An active or untreated local or systemic fungal, bacterial, or viral infection?
• Currently taking systemic corticosteroid treatment, such as Prednisolone
• Have an untreated localised infection around/within the nose, for example, herpes simplex

• I confirm the above questions have been answered truthfully and accurately. I understand that any incorrect information may be detrimental to my health
• I confirm the medication is for my personal use only and I should inform my GP of any treatment I receive from e Shop Pharmacy
• I confirm I will take the medication as prescribed or directed for its intended use and if requesting fexofenadine, I confirm I have previously tried other antihistamines without success
• I have read the patient information leaflet and I will contact a medical professional if I have any questions or experience any side effects while taking the medication
• All information provided will be handled in the strictest confidence in line with GDPR regulations. I am happy for e Shop Pharmacy to collect and use the information I provide for the purposes of providing treatment for my medical condition
• I am happy to be treated by the prescribers and health care professionals at e Shop Pharmacy and the final decision on whether to provide treatment will be with the prescriber and or pharmacist
• I understand if my symptoms do not improve after 2 weeks after starting this treatment I should stop taking this medicine.
• I understand I should not take indigestion remedies or ulipristal (also known as EllaOne or Esmya) 2 hours before or after you take this medicine
• I understand that this medication may cause drowsiness which may affect my ability to drive or operate machinery. I agree if this happens, I will not drive or use tools or machines. I understand that by drinking alcohol whilst on this medication may make me feel more drowsy
• I will not take grapefruit, apple or orange juice with this medication as it can increase the risks of side effects
• I have read and accept the terms & conditions and privacy policy