Are you over 18 and under 65?

Were you assigned female gender at birth?

Have you been diagnosed with yeast infection in the past?

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

AcenoCoumarol Acalabrutinib Alprazolam Amifampridine Aminophylline Amiodarone Amisulpride Anagrelide Apalutamide Apomorphine Arsenic Toxin Artenimol Bedaquiline Bosutinib Carbozantinib Carbamazepine Ceritinib Chlorpromazine Ciclosporin Citalopram Clarithromycin Clomipramine Cobimetinib Crizotinib Dasatinib Delamanid Desflurane Disopyramide Domperidone Dronedarone Droperidol Efavirenz Eliglustat Encorafenib Entrectinib Eplerenone Eribulin Erythromycin Escitalopram Fingolimod Flecainide Glasdegib Granisetron Haloperidol Hydroxyzine Ibrutinib Inotuzumab ozogamicin Isoflurane Lapatinib Lenvatinib Levomepromazine Lithium Lofexidine Methadone Midazolam Mizolastine Moxifloxacin Neratinib Nilotinib Ondansetron Osimertinib Paliperidone Panobinostat Pasireotide Pazopanib Pentamidine Pimozide Piperaquine Quinine Ranolazine Ribociclib Rifabutin Risperidone Saquinavir Sevoflurane Sildenafil Sorafenib Sotalol Sulpiride Sunitinib Tacrolimus Telavancin Tetrabenazine Telacaftor Tizanidine Tolterodine Toremifene Vandetanib Vardenafil Vemurafenib Venlafaxine Vernakalant Vinflunine Warfarin Zupenthixol

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.

Have you had any bleeding outside of your normal cycle or after sex or have you developed any sores, blisters or ulcers in or around your vagina?

Are you currently pregnant?

Have you got poorly functioning kidneys or are you currently receiving treatment for kidney disease?

Have you been advised that you have a prolonged QT interval on an ECG?

Have you had more than 2 episodes of thrush in the past 6 months?

Have you ever had an allergic reaction to fluconazole?