Questions from your Pharmacist

Are you male?*

Yes
No

What is your date of birth?*

This product is only suitable for individuals aged 18 and above.

Is this medication being used by you to treat erectile dysfunction?*

Yes
No

Has your doctor ever advised you not to have intercourse for medical reasons?*

Yes
No

Have you ever had an allergic reaction to erectile dysfunction medication? Or any other allergies?*

Yes
No

Have you ever had an allergic reaction to erectile dysfunction medication? Or any other allergies box

Are you taking any other medication? Including over the counter medicine, herbal medicine or recreational drugs?*

Yes
No

Are you taking any other medication? Including over the counter medicine, herbal medicine or recreational drugs box

Are you overweight?*

Yes
No

BMI Drop Down*

Do you smoke or drink?*

Yes
No

Is there any other relevant medical information that would help our prescribers to prescribe this medication safely to you?*

Yes
No

Is there any other relevant medical information that would help our prescribers to prescribe this medication safely to you box

Do you have diabetes, high blood pressure, high cholesterol, a history of stroke, prostate problems, liver or kidney disease or mental health problems?*

Yes
No

Do you have diabetes box

Do you have any of the following?*

Yes
No

Any heart problems including; heart failure, unstable angina, chest pain, irregular heart beats (arrhythmia e.g. atrial fibrillation or flutter, especially if you are taking medication to treat this e.g. beta blockers or anticoagulant e.g. warfarin), aortic stenosis or uncontrolled blood pressure A heart operation, heart attack or stroke (including a mini stroke) in the last 6 months A history of low blood pressure Difficulty walking at a fast pace for 5 minutes or more due to chest pain, calf pain or shortness of breath Any condition which affects the shape of the penis such as cavernosal fibrosis, angulation or Peyronie’s disease Loss of vision due to NAION (lack of oxygen to the optic nerve) or eye conditions including retinitis pigmentosa, or temporal arteritis Blood conditions including sickle cell anaemia or haemophilia Leukaemia or multiple myeloma Galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption Active stomach ulcers

Do you have any of the following box

Please consent to the following:*

Please consent to the following:

I have read the patient information leaflet and understand the risks and benefits of taking this medicine.
I have answered all of the above questions accurately and confirm that the medication is for my personal use only.
I understand that finasteride should not be taken by women and in pregnancy, it may harm the unborn foetus. Also, women of childbearing age should not handle crushed or damaged finasteride tablets.
I agree to be treated by the prescribers and healthcare professionals at Linthorpe Pharmacy for my medical condition.
I will contact a medical professional if I have any questions or experience any unusual side effects from my treatment. I understand that I should inform my own GP that I am taking this treatment so they can see a full and accurate picture of my health.
We collect information about your health to make a medical diagnosis and prescribe medicines safely. Under the GDPR this type of data is classed as sensitive and therefore we take further precautions when collecting and processing it. By consenting to this notice, you are giving us permission to process your health data for the purposes of prescribing medicine.
Please be aware that Finasteride can affect the results of a PSA test for prostate cancer. If you ever require a PSA test you must inform the doctor you are taking Finasteride
I understand there have been rare cases of patients developing depression whilst on this medication. If I develop depression, I will stop taking this medicine immediately and inform a healthcare professional.

Consent*

I've read and accept the Terms & Conditions and Privacy Policy.*

CAPTCHA

Sildenafil 100mg x4

Details:

Quantity:

Help?

We’re here for you

Step 1 of 2

Please enter your details

Newsletter