Important updates

Email Address

info@yourpharmacy.uk

Phone Number

0114 400 0181

Our Location

26 Greenhill Main Road

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Important updates

Home
Weight Loss
Services
Men’s Health
Women’s Health
Travel Clinic
Skin Care
Hayfever and Allergy

Next Strength

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Step 1 of 5

20%

Your Name*

First Last

Phone*

Email*

Date*

Day

Month

Year

Gender*

Street Address*

City*

County / State / Region

Post Code*

Country*

What is your weight? (include units)*

What is your height? (include units)*

What is your current treatment plan?*

Have you experienced any side effects/ adverse reactions?*

Yes

No

Have you noticed any health/ lifestyle improvements since starting the treatment?*

Additional comments or concerns?*

Are you experiencing any difficulty in administrating the treatment (e.g. injection/ dosing schedule)?*

Next Steps

Are you comfortable on the dose you are currently on?*

Do you want to increase dose or stay the same?*

Patient's Agreement

Do you agree to the following statement - I understand and have answered the questions above honestly*

Yes

No

Do you agree to the following statement - I will read the patient information leaflet provided with the medicine specifically the side effects and dosages.*

Yes

No

Do you agree to the following statement - I understand the importance of notifying my GP about medicines and advice I may receive from this service so they can continue to provide safe medical care.*

Yes

No

Availability

When would be ideal for us to contact you for a phone call? (For additional questions and appointment)*

Comments

This field is for validation purposes and should be left unchanged.

Pharmacy Info

Company Registration: 14116972
Premises GPhC Number: 9012029
Superintendent: Adil Amini (2083818)

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Contact

26 Greenhill Main Road, Sheffield, South Yorkshire, S8 7RD
0114 400 0181
Info@yourpharmacy.uk

Opening Hours

Mon – Fri: 09:00 to 17:00
Saturday: Closed
Sunday: Closed

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Step 1 of 9

11%

Pharmacy First Sore Throat Consultation

Patient Acknowledgement

By completing this consultation you agree to YourPharmacy's Terms and Conditions and Privacy Policy.

Important Information

You must not complete this consultation if you are experiencing any of the following

If any of these apply you must call 999 immediately

Difficulty breathing or swallowing.

Breathing that sounds abnormal or high-pitched.

A muffled or hoarse voice drooling.

If you have any of these other conditions you must not wait for a response from us and contact your GP or 111 immediately.

A weakened immune system

You are not producing as much urine as usual.

Feeling to unwell to care for yourself, for example simple tasks like washing or making food.

A fever with feeling generally weak, dizzy or excessively tired

I agree to the terms and I confirm none of the listed conditions apply to me

Name(Required)

These must match your NHS file

First Last

Date of Birth(Required)

DD slash MM slash YYYY

What is your gender(Required)

This much match your NHS file

NHS number (if known)

Email Address(Required)

Phone Number(Required)

Address(Required)

Street Address City ZIP / Postal Code Country

How long have you had as sore throat?(Required)

Have you felt feverish in the past 24 hours?(Required)

Yes

No

Have you checked your temperature recently?(Required)

Yes

No

Please enter the reading below (°C)

Do you have a cough?(Required)

Yes

No

How long have you had the cough?(Required)

Do you have a blocked or runny nose?(Required)

Yes

No

Do you have a rash or does your skin feel rough, like sandpaper?(Required)

Yes

No

I'm not sure

Are the glands in your neck swollen AND tender?(Required)

These are the glands under your jaw, chin, and either side of your neck. Feel if they are enlarged and tender with your fingertip.

Yes

No

I'm not sure

Are your tonsils red or swollen?(Required)

Yes

No

I'm not sure

Do you have yellow or white spots on them?(Required)

Yes

No

I'm not sure

Are you able to take a clear photo of your tonsils?(Required)

If you are able to, we will ask you to upload a photo on the next screen.

Yes

No

Upload a Photo(Required)

Tips for taking a good photo

Make sure you have adequate lighting

Make sure the subject is clear and in focus.

Drop files here or

Max. file size: 256 MB, Max. files: 3.

Do you have any allergies?(Required)

Yes

No

Please specify more details(Required)

Please list any allergies and the reactions you have.

Do you have a condition or use any medications that cause you to have a weakened immune system?(Required)

For example, receiving chemotherapy, long-term steroid treatment, or have an underlying condition such as leukaemia or HIV.

Yes

No

What is the cause of your weakened immune system?(Required)

Please select the statement that best suits your circumstance.(Required)

I am pregnant

I'm trying to conceive

I am breastfeeding

None of the above

One of our pharmacists may need to contact you whilst they are processing your consultation, when would be the best time to contact you?

We can’t guarantee a time and will only contact you during opening hours, (Mon - Fri, 9am to 5pm)

Patient Agreement

By completing this consultation you agree to the following:

You answered all the questions correctly and to the best of your ability

You consent to YourPharmacy contacting you via phone or email to ensure the best possible care

You confirm you do not NEED URGENT medical attention, if so ring 999.

I agree

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