Medical Assessment - Losec MUPS (Omeprazole) 20mg capsules

Your Symptoms
Are you experiencing acid reflux at least twice a week? Symptoms include:
  • Heartburn - a burning feeling in the chest just behind the breastbone that occurs after eating and lasts a few minutes to several hours
  • Chest pain, especially after bending over, lying down or eating
  • Burning in the throat, or hot, sour, acidic or salty-tasting fluid at the back of the throat
  • Feeling of food "sticking" in the middle of the chest or throat
Are you experiencing any of the following?
  • difficulty swallowing
  • unintentional weight loss
  • abdominal swelling
  • persistent vomiting
  • severe/persistent diarrhoea
  • vomiting blood
  • blood in your stools or black, tarry stools
  • have iron deficiency anaemia
  • severe liver problems
Your Health
Do you have an allergy (hypersensitivity) to medicines containing proton pump inhibitors (e.g.omeprazole, pantoprazole, lansoprazole, rabeprazole, esomeprazole)?
Are you breast feeding or pregnant or possibly pregnant?
Do you have any of the following conditions:
  • Osteoporosis
  • Liver problems
  • Gastric cancer
  • Hypomagnesaemia (low magnesium in the blood)
Have you ever developed a ring-shaped or plaque-shaped rash after sunlight exposure, at a time you have been actively taking a proton pump inhibitor?
Your Medication
Are you currently taking any medication (including over the counter, prescription or recreational drugs)?
Agreement
Do you understand that healthy eating, reduced alcohol consumption, a healthy body weight and smoking cessation are advisable?
Do you understand that acid reflux treatment supplied through this service can only be used for the short-treatment of gastroesophageal reflux disease (GORD) also known as heartburn/acid indigestion for a maximum of 28 days?
Do you understand that if you experience no relief after 14 days or your symptoms persist after 28 days of treatment you must contact your GP for further diagnosis/treatment?
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: help@medexpress.co.uk