Chlamydia Prescription

Your Health

Are you aged 18 years or over?

Yes No

Have you or a sexual partner of yours tested positive for Chlamydia (either using a home testing kit, or with a medical professional/ at a sexual health clinic)?

Yes No

Do you have any of the following symptoms:

Mucous or discharge from the bottom
Blood or large amount of discharge from the penis
Bad smelling vaginal discharge
Vaginal bleeding not due to your period
Severe pelvic or lower abdominal pain
Sudden pain in testicles or swelling of testicles
Fever or feeling hot and cold

Yes No

Do you have a known allergy or hypersensitivity to doxycycline, other tetracycline medications, or any of the other ingredients in doxycycline capsules?

Yes No

Are you pregnant or breastfeeding?

Yes No

Medical Conditions

Do you have the following conditions:

Kidney problems
Liver problems
Heart problems
Myasthenia Gravis
Porphyria
Alcohol dependence
Oesophagitis
History of Systemic Lupus Erythematosus (SLE)
Benign intracranial hypertension

Yes No

Medication

Do you take any of the following medications:

Warfarin, acenocoumarol, or phenindione
Currently taking a penicillin for an infection
Ciclosporin
Lithium
Methotrexate
Rifampicin
Retinoids, such as tretinoin or isotretinoin
Carbamazepine, phenobarbital, or phenytoin

Yes No

Agreement

Are you aware that:

It is important that, where possible, your sexual partner(s) are contacted to let them know they may have caught chlamydia
You should go to a sexual health clinic after 7-10 days of treatment to be re-assessed and to check for any other STIs
You should undertake a repeat chlamydia test 3 months after completing treatment
You should avoid any sexual intercourse (including oral and anal sex) until you and all parties with whom you engage in sexual activity have had the 7 days of treatment
It may take 1-2 weeks for symptoms to go (if you are experiencing any symptoms)

Yes No

Are you aware that of:

A 2-hour gap should be left between taking doxycycline and any indigestion remedies or medicines containing zinc
You should protect your skin from sunlight whilst taking doxycycline, even on a cloudy day. Use of sunbeds should be avoided during this 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.

Medical Assessment

Your Health

Medical Conditions

Medication

Agreement

GP Details

Verify your BMI

Upload Your ID

Your chlamydiya Treatments

Doxycyline 100mg Capsules

Need Some Extras?

Valupak Multivitamin

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