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Acid Reflux Prescription

Medical Assessment

Answer a few quick and easy questions from our pharmacists to see what treatments you’re eligible for.

Your Health

Are you aged 18 years or over?

Yes No

Your answer changed, Can you share why your response changed?

Are you experiencing symptoms of indigestion and acid reflux at least twice a week? Symptoms include:

Heartburn (a burning sensation in the middle of your chest)
Burning sensation in your throat or an unpleasant sour taste in your mouth, caused by stomach acid
A cough or hiccups that keep coming back
A hoarse voice
Bad breath
Bloating and feeling sick

Yes No

Your answer changed, Can you share why your response changed?

Are you over the age of 55 experiencing any new or worsening symptoms?

Yes No

Your answer changed, Can you share why your response changed?

Do you have any of the following symptoms:

Difficulty swallowing
Unintentional weight loss
Abdominal swelling
Persistent vomiting
Severe/persistent diarrhoea
Vomiting blood
Blood in your stools or black, tarry stools
Jaundice (yellowing of skin and eyes)
Anaemia
Food getting stuck in your throat
Chest pain that radiates to the left arm

Yes No

Your answer changed, Can you share why your response changed?

Do you have any known allergies or hypersensitivities to any ingredients in medications known as proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, esomeprazole)?

Yes No

Your answer changed, Can you share why your response changed?

Are you pregnant or breastfeeding?

Yes No

Your answer changed, Can you share why your response changed?

Medical Conditions

Do you have any of the following conditions:

Osteoporosis
Liver problems
Kidney problems
Gastric cancer
Hypomagnesaemia (low magnesium in the blood)

Yes No

Your answer changed, Can you share why your response changed?

Medication

Do you take any other medications?

Yes No

Your answer changed, Can you share why your response changed?

Do you take any of the following medications:

Medication for HIV such as atazanavir, nelfinavir, raltegravir, saquinavir, ritonavir
Clopidogrel
Clarithromycin
Escitalopram
Clozapine
Erlotinib, lapatinib, dabrafenib (used to treat cancer)
Digoxin
Drugs that may cause hypomagnesaemia (e.g. diuretics)
Anti-fungals such as posaconazole, itraconazole, ketoconazole
Warfarin and other vitamin K antagonists
Cilostazol
Ledipasvir
Diazepam
Phenytoin or fosphenytoin
Ciclosporin or tacrolimus
Methotrexate
Rifampicin
St Johns wort
Vitamin B12 such as cyanocobalamin or hydroxocobalamin
Ulipristal

Yes No

Your answer changed, Can you share why your response changed?

Agreement

Are you aware that:

Very rare cases of subacute cutaneous lupus erythematosus (SCLE) and Steven-Johnson’s Syndrome have been reported in patients taking proton-pump inhibitors (PPIs). If you develop any lesions, especially in sun-exposed areas of the skin, you should stop taking the medicine, avoid exposing the skin to sunlight, and see a doctor as soon as possible
If you are at risk of osteoporosis, you should ensure you maintain an adequate intake of calcium and vitamin D, and if necessary, receive other preventative therapy
If you take this medication for a long period of time you may be at risk of vitamin B12 deficiency. You can help avoid this by taking dietary B12 found in meat, fish, milk, cheese and eggs. You can also take a vitamin B12 supplement. Please discuss any concerns with your GP

Yes No

Are you aware that certain lifestyle modifications, such as avoiding/stopping smoking, avoiding spicy foods, and maintaining a healthy weight, can help reduce symptoms of acid reflux?

Yes No

Do you agree to see your GP if there is no improvement in symptoms after 14 days of treatment or symptoms get worse despite treatment?

Yes No

Do you agree to the following:

You will read the patient information leaflet before using this medication
You are aged 18 years or over
You have answered all questions truthfully and accurately
If you have an NHS Summary Care digital record, our specialists can check it to ensure this medication is safe for you
You understand that we take your answers in good faith and any false or incorrect information given can be hazardous to your health
This treatment is solely for your own use
You will inform your GP that you have been prescribed this medication if this is appropriate
You will contact us and inform your GP if you experience any side effects with your treatment, you start any new medication/your medical conditions change during treatment
You are capable of making your own decision about your healthcare and have the capacity to do so

Yes No

GP Details

We can notify your GP of your treatment for you. To do so, we need their contact information. Sharing this information allows your GP to maintain a comprehensive record of your medical history, which is crucial for your health. Without complete records, there could be potential risks to your well-being.

I consent to YourMedicals contacting my GP and share information about my prescription.

Yes No

Practice/GP Name

Practice/GP Address

Verify your BMI

To comply with regulations and ensure the safe provision of weight loss treatment, we need to verify your BMI. You may complete this step later, but we cannot proceed with your prescription until it is provided.

Upload Now Upload Later

Upload Your ID

Please upload a government-issued photo ID that meets the following criteria:

Clearly shows your face, name, and date of birth.
Ensure the image is free from reflections and blurriness.
All four sides of the ID must be visible.

Why We Request a Photo ID

We prioritise your safety and ensure compliance with medical regulations. Our prescribing team requires a government-issued photo ID to:

Verify your identity.
Ensure that all information you have provided matches the details on your ID.

Your information is handled with the utmost confidentiality and security

Upload ID

You have chosen to upload your documents at a later time. A confirmation email will be sent to you shortly with instructions for uploading.

Please note, your order will be placed on hold until the required documents are uploaded. Once the documents are provided, we will proceed with processing your order.

Complete our 2 minute questionnaire

Confidential

Our prescribers will carefully review your information with full confidentiality.
Your medication will be delivered in plain, unmarked packaging
All data is securely encrypted using 128-bit SSL encryption.

Need help?

Quantity

£34.99

Need Some Extras?

Valupak Vitamin D3 1000IU (25mcg) - 60 Capsules

£1.99

Valupak Multivitamin

£1.99

Cyanocobalamin 50mcg Tablets (Vitamin B12)

£1.99

£1.99

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