Malaria Prevention Form / Malaria Prevention / General Health / Browse Categories | Goodcure

Which country are you travelling to? *

Use the Travel Health Pro Country checker to check what anti-malarials (if any) are advised for your trip.

Please confirm you have checked the location you are travelling to by the above link, or via another reputable source to confirm which anti-malarials (if any) are advised for your trip. *

I confirm

Please provide your weight (in kilograms) *

Are you pregnant or breastfeeding or intending to become pregnant or start breast feeding? *

Yes
No

Have you been diagnosed with any of the following? *

Kidney disease
Liver disease
Mental health conditions (including depression or anxiety)
Epilepsy or convulsions
Myasthenia gravis
Systemic lupus erythematosus (SLE)Porphyria (a genetic disorder of the blood)
Blackwater fever
Any serious medical condition which may require immediate hospitalisation
NONE OF THE ABOVE

Please list any other conditions (if any) that you have been diagnosed with.

Please list any prescribed medicines, supplements or herbal preparations? (This includes treatments for unrelated conditions, treatments bought over the counter, inhalers, recreational drugs, creams etc.

Please list any allergies and intolerances that you suffer from (if any) below.

In the field below, please include any other information you would like to provide which you think may be useful for our prescriber (Optional).

Click on the links below to access the terms and conditions, and the privacy policy. Please ensure that you have read them carefully.

Goodcure Pharmacy Terms and Conditions

Goodcure Pharmacy Privacy Policy

I have understood and agree to the Goodcure Pharmacy's terms and conditions as well as the Privacy Policy
This treatment is solely for my own use
I understand that if I experience any flu-like symptoms after returning from my trip for up to a year after I return, I should seek immediate medical attention and tell the doctor about my background and recent travel history
I consent to my details, including IP address, being securely processed and cross-checked by Stripe Radar® for fraud and misuse prevention, as well as Didit® for identity and age verification.
I confirm that all the information that I have provided is correct and accurate to the best of my knowledge. I understand that prescribers take my answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to my health. I understand that Goodcure Pharmacy cannot be held responsible for any harm whatsoever resulting from inaccurate information provided my myself.
I agree to read the product information leaflet carefully and ensure that I understand it well before using any product or treatment provided by Goodcure.
I agree that should I experience any adverse effects resulting from treatment or products obtained from Goodcure Pharmacy, I will discontinue the treatment immediately and seek medical advice as soon as possible.
I am aware that Goodcure Pharmacy, in accordance to their professional and moral duty, may report any cases where misuse of treatments or the illegal selling of treatments is suspected.

Please tick the box below to confirm that you understand and agree to the above important points: *

I understand and agree to all of the above

First Name *

Last Name *

Date of Birth *

Street Address *

Town/ City *

Post Code *

Contact Number *

Email Address *

Name of Registered GP surgery *

GP Surgery Street Address *

GP Surgery Postcode *

Online Consultation

Trusted UK Pharmacy

OPENING HOURS

OTHER INFORMATION

EXTERNAL SITES

LEGAL INFORMATION