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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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Cold Sore 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. What is the site of the cold sore?

      3. Are planning to use aciclovir whilst pregnant or are breast feeding?

        Manufacturers recommend avoidance in pregnancy and breast-feeding. We are not able to prescribe aciclovir for you.

        Yes

        No

        4. Have you been diagnosed with reduced immunity from any cause?

        • For instance you have had a bone marrow transplant or low white count.
        • Note: most people who are troubled with cold sores have normal immune systems.
        Please see your regular doctor if you are troubled with cold sores. We are not able to prescribe aciclovir for you.

        Yes

        No

        5. Have you been diagnosed with kidney disease?

        • Includes conditions which could reduce kidney function ? does not include occasional urinary infections.
        Please see your regular doctor. We are unable to prescribe aciclovir for you.

        Yes

        No

        6. Are you taking the medication probenecid (used to treat gout)?

          There is a possible interaction between aciclovir and probenecid. We are not able to prescribe aciclovir for you.

          Yes

          No

          7. Are you aware aciclovir cream is not for internal use or for use in or around the eye?

          • Not for use in the vagina, mouth or anus.
          Aciclovir cream is not for internal use or for use in or around the eye. You can change your answer and continue.

          Yes

          No

          8. Are you aware you should seek medical advice if sores are getting worse or are not healing after 10 days?

            You should seek medical advice if sores are getting worse or are not healing after 10 days. You can change your answer and continue.

            Yes

            No

            9. Do all of the following apply to you?

            • I will read the patient information leaflet supplied with my medication.
            • The medication is for my own use. (Partners, spouses etc must log out, complete their own consultation and register separately)
            The conditions must apply for you to be able to use this service.

            Yes

            No