Have you previously experienced an allergic reaction to antihistamines such as fexofenadine, loratadine or cetirizine or are you lactose intolerant?

Are you breast feeding or pregnant or planning to become pregnant in the next 6 months?

Have you taken antihistamine tablets before?

Are you taking any oral medications for allergies/hayfever?

Do you understand there is a possibility that oral antihistamines may cause drowsiness and affect driving or operating machinery? You should check that the antihistamine tablets you receive do not make you feel sleepy or dizzy before driving or operating machinery.

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?

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 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 been diagnosed with any of the following?

Kidney or liver problems A history of heart problems such as an irregular or fast heartbeat or angina Epilepsy