Chlamydia

Are you requesting Chlamydia treatment because either:

• You had a Positive test for Chlamydia in the last week, Or
• A Sexual Partner has you they have Chlamydia

Do you have any of the following symptoms:

• Pain or burning when passing urine
• Vaginal/Penile discharge
• Pain in the lower abdomen
• Abdominal pain during sex
• Pain or discharge from your anus/rectum
• Unexpected or unusual bleeding

• Liver or Kidney disease
• Systemic lupus erythematosus (SLE)
• Myasthenia gravis
• HIV

Informed Consent

• I have answered these questions accurately and truthfully and I will contact E Shop Pharmacy if there is any answers to my questions are incorrect. I understand any incorrect information maybe detrimental to my health
• I am over the age of 18 years old and I am requesting this medication for myself and any prescribed treatment is for my personal use only
• The information provided will be collected and processed in accordance with GDPR regulations. I agree for my information to be processed by the E Shop Pharmacy in order to provide any treatment and that the prescribers will ultimately have the final decision whether to prescribe any medication
• If I suffer any side effects from my treatment I will contact E Shop Pharmacy and or my GP immediately
• I will read the patient information leaflet before taking the medication and I will contact a health care professional if I have any questions relating to my treatment or the information contained within it
• I should avoid sexual contact for 7 days following treatment
• I should tell any sexual partner(s) in the last 6 months that they may have caught chlamydia and so should be tested themselves.
• I should inform my GP that I am taking this medication
• I confirm I do NOT have a temperature above 38°C. This may indicate a serious infection. and you should contact your GP or a clinic urgently for an in-person assessment.