Before we begin
Answer a few quick questions so our clinical team can check whether this service may be suitable for you before your consultation. This usually takes 2–4 minutes. Treatment is subject to clinical suitability.
Question 1 of 14
Full name
Based on your answers, this service may not be suitable online. Please contact your GP, NHS 111, or seek urgent care if symptoms are severe.
Question 2 of 14
Date of birth
Based on your answers, this service may not be suitable online. Please contact your GP, NHS 111, or seek urgent care if symptoms are severe.
Question 3 of 14
Postcode
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Question 4 of 14
Email address
Based on your answers, this service may not be suitable online. Please contact your GP, NHS 111, or seek urgent care if symptoms are severe.
Question 5 of 14
Mobile number
Based on your answers, this service may not be suitable online. Please contact your GP, NHS 111, or seek urgent care if symptoms are severe.
Question 6 of 14
Are you completing this for yourself?
Based on your answers, this service may not be suitable online. Please contact your GP, NHS 111, or seek urgent care if symptoms are severe.
Question 7 of 14
Do you take nitrate medicines for chest pain or angina? (e.g. GTN spray, isosorbide)
Based on your answers, this service may not be suitable online. Please contact your GP, NHS 111, or seek urgent care if symptoms are severe.
Question 8 of 14
Do you have any of the following?
Select all that apply.
Based on your answers, this service may not be suitable online. Please contact your GP, NHS 111, or seek urgent care if symptoms are severe.
Question 9 of 14
How would you describe your blood pressure?
Based on your answers, this service may not be suitable online. Please contact your GP, NHS 111, or seek urgent care if symptoms are severe.
Question 10 of 14
Are you taking any regular medicines?
Based on your answers, this service may not be suitable online. Please contact your GP, NHS 111, or seek urgent care if symptoms are severe.
Question 11 of 14
Please list your regular medicines
Include prescription medicines, over-the-counter drugs and supplements.
Based on your answers, this service may not be suitable online. Please contact your GP, NHS 111, or seek urgent care if symptoms are severe.
Question 12 of 14
Do you have any known allergies?
Based on your answers, this service may not be suitable online. Please contact your GP, NHS 111, or seek urgent care if symptoms are severe.
Question 13 of 14
Please describe your allergies
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Question 14 of 14
Do you confirm that all the information you have provided is accurate and complete?
Based on your answers, this service may not be suitable online. Please contact your GP, NHS 111, or seek urgent care if symptoms are severe.
Ready to submit
Your answers will be reviewed by our clinical team. Treatment is only supplied where clinically appropriate.
Based on your answers, this service may not be suitable online. Please contact your GP, NHS 111, or seek urgent care if symptoms are severe.