Sore Throat & Tonsillitis

- tell us about your condition

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Intro

Medical

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Date of Birth (dd/mm/yyyy)

What is your age?

What sex were you assigned at birth?

Please confirm that you understand the following:

Are you currently experiencing any of the following?

Do you currently have a temperature above 38°C

Yes

Unsure

Have you required urgent medical assessment, NHS 111 advice, an urgent care visit or hospital assessment for your current symptoms?

Yes

Please provide details.

Do you feel able to drink enough fluids to stay hydrated ?

Yes

Unsure

Which symptoms are you currently experiencing ?

Which symptom is bothering you the most?

When did your symptoms start?

Today

1–2 days ago

3–7 days ago

More than 7 days ago

Have your symptoms been present for longer than 2 weeks?

Yes

Are your symptoms:

How would you rate your symptoms?

Mild

Moderate

Severe

Have your symptoms improved and then become worse again?

Yes

Unsurw

Are both tonsils affected?

Yes

Unsure

Have you noticed white patches, pus or exudate on your tonsils ?

Yes

Unsure

Have you developed a cough since your symptoms started?

Yes

Have you had a runny nose, blocked nose or cold symptoms?

Yes

Have you recently lost your voice or become hoarse?

Yes

Have you had a fever during this illness ?

Yes

Unsure

Have you noticed swollen or tender glands in your neck ?

Yes

Unsure

Have you been able to eat and drink normally?

Yes

Reduced but still managing

Struggling significantly

How much are your symptoms affecting your normal daily activities?

Not at all

Mildly

Moderately

Severely

Do you believe your symptoms are continuing to worsen despite self-care measures ?

Yes

Unsure

Have you used any of the following during this illness?

If you have used self-care measures, have they helped?

Yes

Partially

Not applicable

Are you currently pregnant?

Yes

Unsure

Are you trying to become pregnant

Yes

Are you breastfeeding?

Yes

Have you experienced tonsillitis or significant throat infections before?

Yes

Have you experienced tonsillitis or significant throat infections before?

Yes

If yes, approximately how many episodes have you experienced in the last 12 months?

2-3

4-6

More than 6

Unsure

Have you experienced multiple episodes of tonsillitis that have significantly affected work, education or daily life?

Yes

Unsure

Have you taken any antibiotics within the last 3 months?

Yes

Which antibiotic(s) did you take?

Did the treatment help?

Yes

Partially

Unsure

Have you ever been told by a healthcare professional that you experience recurrent tonsillitis?

Yes

Unsure

Have you ever been referred to an Ear, Nose and Throat (ENT) specialist regarding your tonsils?

Yes

please provide details

Do you currently have, or have you previously been diagnosed with, any of the following?

If you selected any of the above, please provide details.

Have you been admitted to hospital or required specialist medical treatment within the last 12 months?

Yes

Please provide details.

Do you have any other medical conditions or health concerns that you believe may be relevant to your consultation?

Do you have any allergies?

Yes

Please provide details of the allergy and the reaction experienced.

Have you ever experienced an allergic reaction after taking an antibiotic?

Yes

Please provide details.

Have you ever been advised that you have a heart rhythm condition or prolonged QT interval?

Yes

Unsure

Are you currently taking any prescription medicines?

Yes

Are you currently taking any medicines purchased from a pharmacy, supermarket or online retailer?

Yes

Are you taking any vitamins, supplements, herbal remedies or alternative medicines?

Yes

Please list all medicines, supplements and remedies you currently take.

Have you ever been advised by a healthcare professional to avoid any antibiotics ?

Yes

Please provide more details

Have you ever taken Phenoxymethylpenicillin (Penicillin V)?

Yes

Did you experience any problems whilst taking it?

Have you ever taken Clarithromycin?

Yes

Did you experience any problems whilst taking it?

Please confirm that you understand the following:

Is there anything else you would like the prescriber to know about your symptoms, medical history, previous treatment experiences or any concerns you may have?

Do you consent to PharmaBee sharing relevant information about any treatment supplied with your GP?

Yes

Please provide a reason if you wish.

Do you have a registered GP in the United Kingdom?

Yes

Please provide your GP surgery details.

I agree that the information I have provided is correct and I give consent to PharmaBee Pharmacy to verify this information with my SCR (Summary Care Records) if required.

Its required to fill all details.

Please confirm the following:

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

I understand that providing false or misleading information may affect patient safety and treatment decisions.

I understand that treatment may not be supplied if it is not considered clinically appropriate.

I understand that additional information may be requested before a decision is made.

I understand that online prescribing has limitations and may not be appropriate for all conditions.

I understand that I should seek urgent medical attention if I experience severe or worsening symptoms.

I understand that any treatment recommendation will be made by a qualified prescriber following review of my consultation.

I confirm that I understand and agree to the above

Please complete all required questions.