Medical Assessment

Have you ever been diagnosed with acid reflux by your GP?

Error Select atleast one option

Have you been prescribed acid reflux medication before?

Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you over the age of 65?

Error Select atleast one option

Are you pregnant or breastfeeding or planning to get pregnant or start breastfeeding while taking this medication?

Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

What symptoms are you experiencing? (please tick all the symptoms that apply to you):











Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

When was the last time you were reviewed by your doctor regarding acid reflux?




Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

How often are you experiencing the acid reflux symptoms?




Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you allergic to omeprazole, lansoprazole, esomeprazole, pantoprazole, ranitidine or to any of the ingredients contained in acid reflux medication?

Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you taking any of the following?

  • HIV medication (such as nelfinavir);
  • corticosteroids;
  • NSAIDS (ibuprofen, naproxen…);
  • ketoconazole, itroconazole (antifungals);
  • any heart medication (such as propranolol, digoxin);
  • asthma medication;
  • epilepsy medication;
  • diabetes medication;
  • antidepressants;
  • blood thinning medication (warfarin, clopidogrel…);
  • rifampicin (used to treat tuberculosis);
  • methotrexate ;
Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you taking any medication not mentioned above?

Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Do you suffer from any of the following?

  • stomach cancer;
  • kidney or liver problems;
  • acute porphyria;
  • diabetes;
  • osteoporosis;
  • any other condition we should know about;
Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Do you agree to the following?

  • if you get a rash on your skin, especially in areas exposed to the sun tell your doctor as soon as you can;
  • to contact your GP if you experience any other ill-effects like pain in your joints;
  • if your symptoms doesn’t improve after 2 weeks of treatment you should see your GP;
  • you answered truthfully to all the questions and you are aware that any incorrect information you provided might present a danger to your health;
  • you will seek medical attention if you experience any unusual side effects;
  • the treatment is solely for your own use to treat acid reflux and for no other condition ;
  • you will read the patient information leaflet supplied with your medication;
Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Please tick the boxes to confirm the following:

Error You must accept the terms and conditions to continue!