Medical Assessment - Ventolin (Salbutamol) Inhaler

About You
Do you know how and when to use your inhaler?
Your Symptoms
Have you called an ambulance or had emergency treatment for breathing problems in the last year?
Do you use your inhaler more than four times a day?
Your Health
Has your Asthma been reviewed by a doctor or nurse within the last 12 months?
Have you been prescribed Ventolin (salbutamol) in the last 12 months?
Is your asthma well controlled?
If you are not sure take the asthma control test here.
Do you have an allergy (hypersensitivity) to Ventolin (salbutamol) or have you had a reaction with an asthma inhaler previously?
Are you breast feeding or pregnant or planning to become pregnant in the next 6 months?
Have you been diagnosed with any of the following?
  • Overactive thyroid gland
  • History of heart problems such as an irregular or fast heartbeat or angina
  • High blood pressure
  • 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)?
Agreement
Do you understand that you must seek medical attention if your asthma does not improve within 1 hour of using your inhaler?
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