1
Your Health
The information you provide us is treated with absolute confidentiality and will be reviewed by our experienced UK prescribers. We ask the following questions to provide the prescriber with an appropriate level of information to make an informed decision on whether the treatment is suitable or not.

What is your gender?

Please provide more detail.

Do you need help completing this questionnaire?

NoYes

Please contact us on 020 7157 9759 or email [email protected] and we can assist you.

Do you believe that you have the capacity to make decisions about your own healthcare?

NoYes

Sorry we can't offer you this treatment, please contact your GP.

Have you been diagnosed with any medical conditions?

NoYes

Please provide more detail.

Are you currently taking any medication? This includes prescription-only, over-the-counter and homeopathic medicines.

NoYes

Please provide more detail.

Do you suffer from any allergies?

NoYes

Please provide details including which allergies and what symptoms you experience.

Is there anything else you would like to include to allow our prescriber to prescribe responsibly?

NoYes

Please provide more detail.

2
Medical Questions

Have you checked the NHS Fit To Travel website and confirmed that this treatment is recommended for the place you are visiting?

Confirm

You must check the NHS Fit To Travel website before placing your order to ensure that this medicine is most suitable based on your travel plans.

Please list all of the countries that you plan to visit in your upcoming trip (including how many days you are in each place)

Have you ever suffered from side effects through taking malaria tablets?

NoYes

Please provide further details.

When are you travelling (month and year)?

How many days long is your trip?

Have you ever had any kind of cancer or kidney problems?

NoYes

Please provide further details.

Have you ever had surgery to remove your spleen?

NoYes

If you have had your spleen removed, you are at more risk of malaria and should take further precautions to protect against it. You may continue with this consultation.

I am aware that no malaria tablet provides 100% protection.

Confirm

I am aware that if I get a fever between ONE week and ONE year after I return, I should seek urgent medical attention and tell the doctor that I was in a malarial zone.

Confirm

3
Consent

Would you like us to notify your GP of the treatment you chose to order today?

NoYes

Please provide details.

Doctor Surgeries

[% doctor_surgery.practice_name %]

No Results found

Searching

I can't find my surgery and would like to edit the address below.

Please enter your GP details below

It is very important that your GP is aware of all the medication you are taking, so that you are receiving the best possible care. You should only select “no” if you are completely sure you do not wish us to tell your GP.

Do you agree to the following:

You understand the prescriber will take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
You are aware you will be subject to a soft check to validate your identity via Experian
You will read the Patient Information Leaflet supplied with your medication
You agree to Cloud Pharmacy terms and conditions and privacy policy.
The treatment is solely for your own use
You have answered all the above questions accurately and truthfully
You will inform your GP of this purchase if appropriate

NoYes

Sorry we can't offer you this treatment, please contact your GP.

If treatment is not suitable, you will be fully refunded and signposted to another point of care. The decision about the treatment is for both the patient and the prescriber to consider, however, the final decision will always lie with the prescriber.

Assessment

Trust Pilot

Medical Questions

2
Medical Questions

3
Consent

Doctor Surgeries

No Results found

Searching

Confirm treatment selection

Useful links

Information

Customer care

External Links

Here to help

Assessment

Trust Pilot

Medical Questions

2Medical Questions

3Consent

Doctor Surgeries

No Results found

Searching

Confirm treatment selection

2
Medical Questions

3
Consent