Consultation - Pills2U

Thrush

Please fill out the form below so that our clinicians can determine if the treatment will be suitable for you to take.

1 About Your Health

Your health and safety are our top priorities. Please provide accurate and complete information during your consultation so we can recommend the most appropriate treatment for you.

Do you have any known allergies?

Are you currently taking any medications?

Do you have any chronic conditions? (e.g., diabetes, hypertension, asthma, etc.)

Have you had any surgeries in the past year?

Do you smoke?

Do you consume alcohol?

How often do you exercise?

Daily

Weekly

Rarely

Never

What is your typical diet like? (e.g., balanced, high-fat, spicy foods)

2 About Your Condition

Please provide accurate and honest details during your consultation. This helps us offer the safest and most effective treatment for you.

How long have you been experiencing symptoms of thrush?

What symptoms are you currently experiencing? (e.g., itching, soreness, redness, white discharge, discomfort during intercourse or urination)

How severe are your symptoms on a scale of 1 to 10 (1 being mild and 10 being severe)?

Have your symptoms interfered with your daily activities or quality of life?

Have you been diagnosed with thrush by a healthcare professional?

Yes

Have you had any tests to confirm the diagnosis? (e.g., vaginal swab, urine test)

Have you identified any possible triggers that worsen your symptoms? (e.g., antibiotics, hormonal changes, tight clothing, high-sugar diet)

Have you been prescribed medication for thrush before?

Are you currently taking any medication for thrush?

Have you experienced any side effects from your current or past thrush medications?

Have you tried any non-medication treatments for thrush? (e.g., probiotic supplements, avoiding triggers, lifestyle changes)

Have you used over-the-counter treatments for thrush?

3 The Agreement and Consent

Please read the Agreement and Consent statements carefully during your consultation. They contain important information to help you stay informed and safe throughout your treatment.

Understanding of Risks

I have been informed about the potential side effects and interactions of the prescribed medication for thrush.

Medical Guidance

I agree to consult with my healthcare provider before starting any new medication.

I understand that the information provided in this assessment will be reviewed by a licensed pharmacist before my order is processed.

Consent to Share Information:

I consent to my personal and medical information being used to assess my suitability for the prescribed medication.

I understand that my information will be kept confidential and used solely for the purpose of this assessment.

Confirmation:

I confirm that the information provided in this assessment is accurate and complete to the best of my knowledge.

I understand that providing false information may result in my order being cancelled and may have health implications.

1 About Your Health
2 About Your Condition
3 The Agreement and Consent

General Health

Hay Fever

Thrush

Weight Loss

Assessment for Thrush

Thrush

1 About Your Health

Do you have any known allergies?

Yes

Are you currently taking any medications?

Yes

Do you have any chronic conditions? (e.g., diabetes, hypertension, asthma, etc.)

Yes

Have you had any surgeries in the past year?

Yes

Do you smoke?

Yes

Do you consume alcohol?

Yes

How often do you exercise?

What is your typical diet like? (e.g., balanced, high-fat, spicy foods)

2 About Your Condition

How long have you been experiencing symptoms of thrush?

What symptoms are you currently experiencing? (e.g., itching, soreness, redness, white discharge, discomfort during intercourse or urination)

How severe are your symptoms on a scale of 1 to 10 (1 being mild and 10 being severe)?

Have your symptoms interfered with your daily activities or quality of life?

Yes

Have you been diagnosed with thrush by a healthcare professional?

Yes

No

Have you had any tests to confirm the diagnosis? (e.g., vaginal swab, urine test)

Yes

Have you identified any possible triggers that worsen your symptoms? (e.g., antibiotics, hormonal changes, tight clothing, high-sugar diet)

Yes

Have you been prescribed medication for thrush before?

Yes

Are you currently taking any medication for thrush?

Yes

Have you experienced any side effects from your current or past thrush medications?

Yes

Have you tried any non-medication treatments for thrush? (e.g., probiotic supplements, avoiding triggers, lifestyle changes)

Yes

Have you used over-the-counter treatments for thrush?

Yes

3 The Agreement and Consent

Understanding of Risks

Medical Guidance

Consent to Share Information:

Confirmation:

Assessment Progress

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