Q1: Are you male?

Q2: Are you under 18 years of age?

Q3: Do you have a confirmed diagnosis of genital herpes by your GP or sexualhealth clinic?

Q4: Is this your first attack of genital herpes?

Q5: Have you been experiencing genital blisters and/or ulcers for more than5 days?

Q6: Have you used any medication to treat genitalherpes before?

Q7: Have you had more than 5 outbreaks of genitalherpes in the past year?

Q8: Are you allergic to any medicines or othersubstances, for example peanuts or soya?

Q10: Do you have any of the following symptoms?

a) Fever
b) Night sweats
c) Generalised body rash
d) Pain when urinating
e) Urinary tract infection
f) Blood in urine or stools
g) Chest pain
h) Unexplained weight loss.

Q11: Do you have previously diagnosed liver, kidneyor urinary problems?

Q12: Have you been diagnosed with immunodeficiencyconditions (weak immune system) or are you actively taking immunosuppressivemedication?

Q13: Have you had any other conditions in and aroundthe genital area such as other sexually transmitted diseases (STI), thrush,abnormal rash/skin conditions within the last 3 months ?

Q14: Please confirm that you are aware of the following

a) You should increase fluid intake to produce dilute urine, which may be less painful to void. Try to urinate in a bath or with water flowing over the area to reduce stinging.
b) You should wash the affected area using salt water (1 teaspoon salt in 500mls of warm water) as needed to ease symptoms, promote healing of lesions, and prevent secondary infection.
c) Avoid wearing tight clothing, which may irritate lesions.
d) You should abstain from sexual activity (including non-penetrative and oro-genital sex) if there are symptoms or lesions are present, until lesions have cleared.
e) Transmission can occur when there are no symptoms ('asymptomatic shedding'), but the risk is higher when a person is symptomatic.
f) Male condoms may reduce the risk of future transmission, but cannot prevent it completely. Transmission is still possible with close skin contact, or contact with infected secretions during foreplay.
g) You should seek immediate medical attention if symptoms do not improve after 7 days.

Q15: Consent

1) I confirm I am over 18 years old.
2) Any medicine ordered is for my sole use only.
3) I will read the patient information leaflet (PIL) supplied with the medicine specifically the side effects and dosages.
4) I take responsibility to inform my own regular doctor/GP of the online consultation or any changes in my circumstances.
5) I have answered all the above questions accurately and truthfully and I am aware that incorrect information can be hazardous to my health
6) I agree to the excelsior terms and conditions.

I agree to the Terms and Conditions and I confirm that I am over 18. You must agree to continue.

Important: Consultation Required Before Order Fulfilment Please note that your order will only be fulfilled after a consultation with our prescriber. Once your order is placed, we will send you a link to book an appointment with the prescriber. Please complete the consultation to confirm your eligibility for the treatment.