Select 'Yes' if you give permission to share this information with or seek more information from your GP, we will hold your order until GP approval has been given. Not providing consent may limit the services provided by the prescriber.
1. Why are you looking to use our service instead of your own GP or other healthcare provider?
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4. Please provide details of the last time you discussed this medical problem with your GP/Consultant. (Please include details such as date seen, their thoughts about your ongoing use of this medication and the next proposed review date.)
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5. Please describe any other symptoms or underlying medical conditions the prescribing doctor needs to be aware of?
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11. Are you taking any of the following:
a. Other medicines used to lower blood sugar i.e. insulin
b. Medicines for asthma such as salbutamol
c. Diuretics (water tablets) such as furosemide or bendrofluazide.
d. ACE-inhibitors such as captopril, ramipril used for heart problems and high blood pressure
e. Beta-blockers such as atenolol
f. Steroids such as prednisolone, used to treat inflammatory and allergic disorders.
12. Do any of the following apply to you:
a. You are allergic ( hypersensitive) to metformin/Glucophage or any of the ingredients in the tablet.
b. You have had serious complication with your diabetes or other serious condition which resulted in rapid weight loss, nausea, vomiting or dehydration and you had fainted or suffered a coma due to your diabetes.
13. Do any of the following apply to you?
a. You are suffering from severe infection or have recently suffer a severe injury.
b. You have any problem with your liver or kidneys.
c. You have been treated for heart problems or have recently had a heart attack or have problem with your circulation including shock or breathing difficulty.
d. You are likely to have a surgery, or as scan or an X-Ray
15. I agree to the following:
a. I will read the patient information leaflet supplied with my medication
b. I will contact my GP or MyMedsUK if I experience any side effects
c. The treatment is for my use only
d. I have answered the assessment questions truthfully and accurately
e. I agree to the Terms and Conditions and I confirm that I am over 18 years old
f. I am aware that I may be contacted to give further information via phone or email and if I am not contactable this will lead to a delay in receipt of my prescription
Based on the answers you have provided, we advise you to visit your GP for a personal consultation. Please make an appointment with your GP at your earliest convenience.
Great, you've be provisionally approved for this treatment. Click 'Continue' to complete your order.
