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Date of birth
Which of the following hayfever (seasonal allergic rhinitis) symptoms are you experiencing? Please tick all the symptoms that apply to you.
For further information kindly contact our patient support team:
0207 867 3932
email help@clickpharmacy.co.uk.
Have you ever used Fexofenadine (Telfast)/ Nasonex (mometasone furoate)/ Beconase (beclometasone dipropionate) or any other antihistamine tablets/corticosteroid spray before (including over the counter medication)?
Are you pregnant or breastfeeding or may become pregnant or start breastfeeding whilst taking this medication?
4) Can you be allergic to Fexofenadine (Telfast), Nasonex (mometasone furoate)/ Beconase (beclometasone dipropionate or to any of their ingredients?
Are you suffering or have you been recently suffering from any of the following?
Can you please provide more details?
Are you taking any other medication (including over the counter preparations) not mentioned above?
Please provide the name, dosage and the reason why you are taking that medication or medications.
Do you agree to the following?
Are you taking any of the following?
Please tick the boxes to confirm the following:
Order before 15:00pm (Monday to Friday) for next day delivery
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