Oral Thrush

(tick all that apply)

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.

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 this assessment. 

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. 

I have been informed about the potential side effects and interactions of the prescribed medication for oral thrush. Specifically, I confirm that I have been informed of the following:

• Purpose of treatment and expected benefits
• Possible side effects (e.g., nausea, diarrhoea, taste disturbances, skin rash)
• Potential risks (e.g., drug interactions with warfarin, liver complications with fluconazole)
• Need to complete the full course and follow administration instructions (e.g., not swallowing miconazole gel immediately)
• Need to report any side effects or concerns promptly

I consent to receive treatment for oral thrush through this online service and understand that my information will be used in accordance with clinical and data protection regulations.