Genital Warts - Medical Assesment

If you have ordered this medication before, you can log in to fill up the questionnaire automatically. Our pharmacists have a few quick and easy questions to help issue your FREE online prescription

About You

Are you aged between 18 and 65?

You must answer the question to continue
We are unable to treat you if you are outside this age range. Please consult your GP or your local GUM clinic.
 

If you are of child bearing potential, are you using effective contraception?

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We cannot supply you with treatment. Please consult with your GP or sexual health clinic.
 

Have you been diagnosed by your GP or GUM clinic with Genital Warts?

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We are unable to treat you if you have not been diagnosed. Please consult your GP or your local GUM clinic.
Symptoms

Are you experiencing any of the following?

  • unintentional weight loss
  • blood in your urine or stools
  • pain when urinating
  • urinary tract infections (UTI)
  • night sweats
  • fever
  • bleeding from the anus or urethra
  • discharge/ fluid from the wart
  • discharge from the penis or vagina
  • swollen lymph nodes
  • abnormal urine flow
  • change in the appearance of your warts since they were diagnosed by a medical doctor
  • warts located internally (inside the urethra, vagina, cervix, rectum or anus)
  • anal warts
  • open, sores or wounds, broken skin or ulcers near your warts including broken skin following surgery
  • bleeding between periods or after sex (women only)
  • warts on foreskin
  • you have had your current outbreak for more than 18 months
  • your warts cover an area larger than 4 cm2
You must answer the question to continue
Consult your GP urgently. These symptoms indicate the possibility of a more serious illness.
Health

Do you have an allergy (hypersensitivity) to medicines containing imiquimod or podophyllotoxin?

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We are unable to supply you with treatment. Please consult your GP.
 

Are you breastfeeding or pregnant or possibly pregnant?

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We are unable to supply you with treatment. Please consult your GP.
 

Have you been diagnosed with any of the following?

  • Liver problems
  • Kidney problems
  • Immunodeficiency/ immunocompromising conditions (eg. HIV, autoimmune conditions/ diseases)
  • Abnormal blood count
  • You have received an organ transplant
  • Your warts cover an area larger than 4 cm2
  • Reduced haematologic reserve
  • Any serious medical condition which may require immediate hospitalisation
You must answer the question to continue
We cannot supply you with treatment. Please consult your GP.
Medication

Are you currently taking any medication (including over the counter, prescription or recreational drugs)?

You must answer the question to continue
 

Are you taking any of the following medications?

  • Any immunosuppressive medication
  • Any other treatment for genital warts
You must answer the question to continue
We are unable to supply you with treatment. Please consult your GP.
Agreement

Do you understand that it is best practice to maintain genital hygiene and avoid sexual contact whilst on treatment, but if you do have sexual contact, please wear a condom?

You must answer the question to continue
We cannot supply you with treatment. Please consult your GP.
 

Do you understand that you should return to your GP or GUM clinic for an examination of your genital warts if they do not improve after 4 weeks of treatment with podophyllotoxin (Warticon) or 16 weeks of treatment with imiquimod (Aldara)?

You must answer the question to continue
You must agree to this before continuing. If you need assistance contact customer support.
 

Do you agree to the following?

  • You will read the patient information leaflet supplied with your medication
  • You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • The treatment is solely for your own use
  • You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.
You must answer the question to continue
You must agree to this before continuing. If you need assistance contact customer support.
You must click on the terms and conditions to continue
01273 204 905

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