Consultation - Mentor Pharmacy

1 About Your Health

Your health and safety are our top priorities. To ensure we provide you with the most effective and appropriate treatment, it is crucial that you provide accurate and complete information about your health during our online consultation process. Accurate information helps us understand your condition better, assess any potential risks, and recommend the best possible medication for your needs. Thank you for your cooperation and trust in our services.

Question 1:Do you have any known allergies?

Question 2:Do you have any chronic conditions? (e.g., diabetes, hypertension, asthma, etc.)

If yes, please detail them here, otherwise please type N/A

Question 3:Are you currently taking any medications?

If yes, please detail them here, otherwise please type N/A

Question 4:Have you had any surgeries in the past year?

If yes, please detail them here, otherwise please type N/A

Question 5:Do you smoke?

Question 6:Do you consume alcohol?

If yes, how much a day/weekly?

Question 7:What is your typical diet like? (e.g., balanced, high-fat, spicy foods)

Question 8:How often do you exercise? (e.g., daily, weekly, rarely, never)

3 The Agreement and Consent

Please read the Agreement and Consent statements carefully during your consultation. They contain important information to help you stay informed and safe throughout your treatment.

Question 1:Understanding of Risks

I have been informed about the potential side effects and interactions of the prescribed medication for acne.

Question 2:Medical Guidance

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.

Question 3:Consent to Share Information

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 the purpose of this assessment.

Question 4:Confirmation

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.

Acne

Asthma

Contraceptives

Eczema and Dermatitis

Erectile Dysfunction

Hay Fever

Menopause

Shingles

Sinusitis

Urinary Tract Infection (UTI)

Ear Wax Removal

Private Blood Tests

Assessment for Acne

Acne

1 About Your Health

Question 1:Do you have any known allergies?

Yes

Question 2:Do you have any chronic conditions? (e.g., diabetes, hypertension, asthma, etc.)

Yes

Question 3:Are you currently taking any medications?

Yes

Question 4:Have you had any surgeries in the past year?

Yes

Question 5:Do you smoke?

Yes

Question 6:Do you consume alcohol?

Yes

Question 7:What is your typical diet like? (e.g., balanced, high-fat, spicy foods)

Yes

Question 8:How often do you exercise? (e.g., daily, weekly, rarely, never)

Yes

2 About Your Condition

Question 1:How long have you been experiencing acne?

Question 2:Have you consulted a healthcare provider about your acne?

Yes

Question 3:What type of acne do you have? (e.g., blackheads, whiteheads, papules, pustules, nodules, cysts)

Question 4:How often do you experience acne breakouts? (e.g., daily, weekly, occasionally)

Question 5:Are there specific triggers that worsen your acne? (e.g., certain foods, stress, hormonal changes)

Yes

Question 6:Have you been prescribed medication for acne before?

Yes

Question 7:Are you currently taking any medication for acne?

Yes

Question 8:Have you experienced any side effects from your current or past acne medications?

Yes

Question 9:Have you tried any non-medication treatments for acne? (e.g., topical treatments, lifestyle changes, dietary modifications)

Yes

Question 10:Have you used over-the-counter acne treatments?

Yes

3 The Agreement and Consent

Question 1:Understanding of Risks

Question 2:Medical Guidance

Question 3:Consent to Share Information

Question 4:Confirmation

Assessment Progress

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