Will you be taking this medicine?:
What is the age, in years, of the youngest intended customer of this product? Please give in months if younger than 1 year. - YY and MM:
What symptoms will the product be used to treat?:
How long have the symptoms been present? - Weeks and Days:
Is the intended customer(s) taking any other medication, prescribed medicines or over the counter medicines including vitamins and herbal remedies?:
Does the intended customer(s) live with any other medical conditions (e.g. diabetes, asthma)?:
Is the person pregnant or breastfeeding?:
I confirm that I have read the information in this questionnaire and will follow the advice shown here and in the product leaflet.:
Will you be taking this medicine?:
What is the age, in years, of the youngest intended customer of this product? Please give in months if younger than 1 year. - YY and MM:
What symptoms will the product be used to treat?:
How long have the symptoms been present? - Weeks and Days:
Is the intended customer(s) taking any other medication, prescribed medicines or over the counter medicines including vitamins and herbal remedies?:
Does the intended customer(s) live with any other medical conditions (e.g. diabetes, asthma)?:
Is the person pregnant or breastfeeding?:
I confirm that I have read the information in this questionnaire and will follow the advice shown here and in the product leaflet.:
Will you be taking this medicine?:
What is the age, in years, of the youngest intended customer of this product? Please give in months if younger than 1 year. - YY and MM:
What symptoms will the product be used to treat?:
How long have the symptoms been present? - Weeks and Days:
Is the intended customer(s) taking any other medication, prescribed medicines or over the counter medicines including vitamins and herbal remedies?:
Does the intended customer(s) live with any other medical conditions (e.g. diabetes, asthma)?:
Is the person pregnant or breastfeeding?:
I confirm that I have read the information in this questionnaire and will follow the advice shown here and in the product leaflet.:
Will you be taking this medicine?:
What is the age, in years, of the youngest intended customer of this product? Please give in months if younger than 1 year. - YY and MM:
What symptoms will the product be used to treat?:
How long have the symptoms been present? - Weeks and Days:
Is the intended customer(s) taking any other medication, prescribed medicines or over the counter medicines including vitamins and herbal remedies?:
Does the intended customer(s) live with any other medical conditions (e.g. diabetes, asthma)?:
Is the person pregnant or breastfeeding?:
I confirm that I have read the information in this questionnaire and will follow the advice shown here and in the product leaflet.:
Subtotal | £13.00 |
---|---|
ShippingShipping options will be updated during checkout. | |
Total | £17.99 (includes £2.17 VAT) |
Will you be taking this medicine?:
What is the age, in years, of the youngest intended customer of this product? Please give in months if younger than 1 year. - YY and MM:
What symptoms will the product be used to treat?:
How long have the symptoms been present? - Weeks and Days:
Is the intended customer(s) taking any other medication, prescribed medicines or over the counter medicines including vitamins and herbal remedies?:
Does the intended customer(s) live with any other medical conditions (e.g. diabetes, asthma)?:
Is the person pregnant or breastfeeding?:
I confirm that I have read the information in this questionnaire and will follow the advice shown here and in the product leaflet.: