Medical Assessment - Aciclovir 400mg

About You
Are you aged between 18 and 65?
Have you been diagnosed by your GP or GUM clinic with Genital Herpes (HSV-1 or HSV-2)?
Your Symptoms
Are you experiencing any of the following?
  • thrush
  • unintentional weight loss
  • chest pain
  • blood in your urine
  • pain when urinating
  • blood in your stools
  • urinary tract infections (UTI)
  • night sweats
  • fever
Your Health
Do you have an allergy (hypersensitivity) to medicines containing Aciclovir or Valciclovir or Famaciclovir or Penciclovir?
Are you breast feeding or pregnant or possibly pregnant?
Have you been diagnosed with any of the following?
  • Liver problems
  • Kidney problems
  • Immunodeficiency conditions (eg. HIV)
  • Nervous system abnormalities
  • Any serious medical condition which may require immediate hospitalisation
Your Medication
Are you currently taking any medication (including over the counter, prescription or recreational drugs)?
Do you understand that you should maintain genital hygiene and avoid sexual contact during your outbreak?
Do you understand that you should drink water regularly during your treatment? This will help reduce side effects that can effect your kidneys or nervous system.
Do you understand that if your symptoms do not improve after 7 days you must see your doctor?
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.

Complete our 2 minute questionnaire
We’re almost done!
Dr Oliver Large
To make sure this treatment is safe for you to take, we just need you to answer a few questions.
Dr Oliver Large
Confidential & Secure
  • Our prescribers will review your details in complete confidence
  • Your medication will be delivered in plain unlabelled packaging
  • Appears on your statement as “Mexpress”
  • All data is securely encrypted with 128bit SSL
Need help? If you need help with this medical assessment, contact our helpline:
0208 123 0508
or email us: