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Medical Assessment for Hay Fever Treatment

Complete this short online consultation so our medical team can show you suitable treatments.

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Tell us about yourself
Are you aged between 18-70?
Are you breast feeding or pregnant or planning to become pregnant in the next 6 months?
Are you pregnant or breastfeeding?
Do you suffer predominantly with symptoms of runny nose, blocked nose, or sneezing?
Have you ever had an allergic reaction to Mometasone Furoate, Beconase (Beclometasone) or Benzalkonium Chloride?
Have you had a previous reaction to any eye drops?
Have you previously experienced an allergic reaction to antihistamines such as fexofenadine, loratadine or cetirizine or are you lactose intolerant?
About Your Symptoms
Do you have symptoms in one eye only?
Your Health Information
Have you been diagnosed with any of the following?
  • Glaucoma/raised intraocular pressure
  • Recurrent or untreated nasal infections
  • Unresolved complications following nasal surgery
  • Diabetes Mellitus
Have you had nasal surgery in the last two months?
Your Current Medication
Are you currently taking any medication (including over the counter, prescription or recreational drugs)?
Are you taking any oral medications for allergies/hayfever?
Have you taken antihistamine tablets before?
Patient Declaration & Agreements
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, you start new medication and/or 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 understand that whilst decisions relating to your treatment are made jointly between you and the prescriber, the final decision to issue a prescription will always be with the prescriber.
Do you understand it can take a few days after starting a nasal steroid spray to see improvement, regular use is required to achieve full benefit and you should consult with you GP if your symptoms do not improve after 4 weeks of treatment?
Do you understand that if you experience any localised side effects such as nasal pain or nose-bleeds you should stop your nasal steroid treatment and see your GP?
Do you understand that if you have not seen improvement in your eye symptoms after 72 hours you will contact your optometrist or GP for further advice.
Do you understand that to get the best results from a steroid nasal spray, you need to use it every day during your hayfever season?
Do you understand that you should not take: Indigestion remedies (such as antacids) or Ulipristal (emergency contraception or treatment for fibroids) 2 hours before or after taking an antihistamine?
Do you understand you should stop taking antihistamine tablets and speak to your GP if your symptoms do not improve after 2 weeks of starting treatment?