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Gender:

Date of birth

Medical Assessment

Are you female?

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.

Which of the following symptoms are you experiencing?











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 have any other discharge or 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.

Have you suffered from cystitis in the past 6 months?

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 suffering from any of the following?

  • strong abdominal (tummy) pain;
  • strong back pain;
  • nausea, vomiting, diziness ;
  • pelvic soreness;
  • racing heart, increased breathing rate or fainting;
  • reduced urine output;
  • you are postmenopausal and have vaginal discharge or itch, and pain during sexual intercourse;
  • any chronical condition that 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.

Have you ever been diagnosed with the following?

  • An allergy to Trimetophrim or its ingredients (e.g. lactose);
  • Any kind of blood dysorder (such as porphyria);
  • Any pulmonary disease;
  • Colitis;
  • Autoimmune conditions (such as psoriasis, rheumatoid arthritis, Crohn´s disease...);
  • Any kidney or liver disease;
  • G6PD (glucose-6-phosphate dehydrogenase) deficiency;
  • Any illness causing severe weakness;
  • Anaemia and/or a lack of vitamin B or abnormal levels of salts in your blood;
  • Gout ;
  • Diabetes;
  • Folic acid deficiency;
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?

  • Medication for gout (probenecid or sulfinpyrazone);
  • Medication for raised pressure in the eye (acetazolamide);
  • Anticoagulants (warfarin);
  • Any other antibiotics (quinolones);
  • Any immunosuppresant drugs (prednisolone, azathioprine, leflunomide...);
  • Monoclonal antibodies ;
  • Oral typhoid vaccine or any other vaccine;
  • Amiodarone;
  • Dapsone;
  • Metronidazol;
  • Magnesium trisilicate;
  • Sodium nitrite or potassium citrate;
  • Phenytoin;
  • Prilocaine;
  • Spironolactone, furosemide or eplerenone;
  • Ciclosporin;
  • Digoxin;
  • 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 other medication not listed 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.

Are you pregnant or breastfeeding or may become 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.

In order for us to prescribe you with antibiotics, we are required to inform your regular GP. Do you give us a consent to inform your GP about the supply of 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.

Please enter your GP's full name and surgery address so we can contact them to advise of the medication you have ordered.

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 Macrobid (nitrofurantoin) or to any of the ingredients it contains?

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 Trimethoprim or to any of the ingredients it contains?

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?

  • You will seek immediate medical attention if your symptoms worsen or not subside after you have finished your treatment;
  • Macrobid may colour your urine yellow or brown – this is harmless;
  • Macrobid may cause dizziness and drowsiness. You should not drive or operate machinery if you are affected this way until the symptoms go away. ;
  • You should only select Trimethoprim as a treatment if allergic or not tollerating Macrobid (Nitrofurantoin);
  • You have answered thrutfully to all the questions and you are aware that any incorrect information you provided can present a potential danger to your health;
  • You will inform your doctor about any unusual side effects;
  • The treatment is solely for your own use;
  • 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:

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Order before 15:00pm (Monday to Friday) for next day delivery