Are you aged 18 and above?

Are you pregnant or breast feeding, or intending either whilst on this medication?

Are you currently taking any oral medication for hayfever/ allergies?

Are you aware that:

• There is a small chance that antihistamine tablets can cause drowsiness and impair driving (even those classified as ‘non-drowsy’)?
• You should stop taking antihistamine tablets and speak to your GP if your symptoms do not improve after 2 weeks of starting treatment?
• 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 with the below:

• The treatment is for your own use
• You will contact us and your GP should you experience any side effects from the treatment, if your condition changes or if your medical circumstances change.
• You will read the patient information leaflet supplied with your medication
• You have completed this questionnaire yourself and fully understand all the information
• Your responses are honest and accurate, and you understand that this is necessary for a safe medical assessment
• You agree to the terms & conditions, privacy policy, & data sharing policy