01493668097
Your Chemists

Office Address

Gorleston Pharmacy, 8 Lowestoft Road, Gorleston, NR31 6LY

Phone Number

01493668097

Email Address

mansour.dadkhah@nhs.net

Information

Company Registration: 7448961 Premises GPhC Number: 1035247 Superintendent: Mansour Dadkhah (2060377)

STI treatments

We can prescribe effective, discreet sexually transmitted infection (STI) treatment if you have been diagnosed with one, such as chlamydia, genital warts or genital herpes. All STI and STD treatments are available for discreet delivery or collect from your local ParcelShop.

  • Background
  • Health
  • Consent
Our doctors would now like to check your suitability for this product

Reason for treatment

What is your sex?

What is your date of birth?

I seek treatment for the following reason:

We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

Are you pregnant or breastfeeding?

Symptoms

Do you have any symptoms that you think are due to chlamydia?

Are you allergic to any of these antibiotics?

Are you allergic to soya or peanuts?

Do you have any of the following? Please tick all that apply.

Do you take any prescribed medication?

We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

Your sexual partners

I confirm the above statements are true Ideally all your sexual partners in the last six months should be traced and told that they need screening for chlamydia. We can do this for you anonymously by sending a text message. Would you like us to do this for you?

Informed consent

I confirm the above statements are true --I have responded honestly and provided complete and accurate information that reflects my up to date medical history and information, so that the doctor can safely assess and advise me.
--I fully understand all the questions and information provided. If I am unsure about any aspect of the service I will contact Your Chemist Online Doctor before proceeding.
--I understand the side effects, effectiveness and alternatives to the treatment I am requesting.
--I understand the importance of notifying my GP about medicines and advice I may receive from this service so they can continue to provide safe medical care.
--I understand this consultation will form part of my Online Doctor medical record and will be kept in line with the relevant retention period.
--I have read, understand and agree to the latest terms and conditions and privacy policy
--If I have further questions in relation to my sexual health or wellbeing, I will contact my GP or healthcare professional.

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