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2nd Floor, Akerman Health Centre
60 Patmos Road, London, SW9 6AF
Tel. 020 3049 6500
Fax. 020 3049 6515
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Sexually Transmitted Infections Online Consultation

Please fill out the form below, and one of our doctors will contact you regarding the consultation:

Patient Information

Name: *
Date Of Birth: *
NHS Number (if known):
Address:
Postcode:
Contact Number: *
E-Mail Address: *

Consultation Information

1. Have you read information about your symptoms on Patient.info?

    It is advised that you read up about this condition and the related symptoms.

    Yes

    No

    2. Have you or a sexual partner of yours had a positive Chlamydia/Gonorrhoea test?

    • Partners and contacts MUST order separately
    You should not take antibiotic without having a positive test result or having a sexual partner who has had a positive test result. We are unable to to prescribe azithromycin for you.

    Yes

    No

    3. Are you allergic to Azithromycin or Erythromycin?

      Yes

      No

      4. Have you been diagnosed with liver, kidney or heart disease?

        Azithromycin may not be suitable. Please see you regular doctor for advice. You may be able to take the alternative antibiotic, a one week course of doxycycline, not available yet from this site. We are unable to prescribe azithromycin for you.

        Yes

        No

        5. Are you taking any of the following medications regularly?

        • Ciclosporin - for reducing immunity after transplant
        • Digoxin - for irregular heart or heart failure
        • Ergotamine - taken rarely for migraine
        • Terfenadine - antihistamine for hay fever and allergy
        • Theophylline - for asthma used rarely
        • Disopyramide - for irregular heart used rarely
        • Rifabutin - rarely used antibiotic
        • Coumarins - anticoagulant for thinning the blood - includes warfarin
        Please see your regular doctor before taking azithromycin. We are unable to prescribe azithromycin for you.

        Yes

        No

        6. Are you pregnant or breast-feeding?

          Please see your regular doctor before taking azithromycin. Manufacturers recommend avoidance. The risk and benefits needs to be assessed. We are unable to prescribe azithromycin for you.

          Yes

          No

          7. Are you aware you should refrain from sexual contact for 7 days after taking treatment, until no longer infectious?

            You should refrain from all sexual contact for 7 days after taking the treatment, until no longer infectious. You can change your answer and continue.

            Yes

            No

            8. Are you aware azithromycin does not treat all sexually transmitted disease?

              You may want to consider having tests for gonnorrhoea, syphilis, HIV, genital herpes, and other sexually diseases not treated by azithromycin. You can change your answer and continue.

              Yes

              No

              9. Are you aware, where possible, you should inform sexual partner(s) of your need to have chlamydia treatment?

              • Partners and contacts MUST order separately
              You should inform sexual partner(s). You can change your answer and continue.

              Yes

              No

              10. Do the following apply to you?

              • I will read the information leaflet supplied with the tablets
              • The medication is for my own use. Partners and contacts MUST order separately, in their own name
              • I am over 18 (non-online treatment is available to younger people via National Chlamydia Screening Program)
              These conditions must apply for you to use this service

              Yes

              No