Traveller's Diarrhoea

If yes, did you experience traveller's diarrhoea during your previous travel?

If yes, please describe your symptoms (e.g., frequent, loose or watery stools, abdominal cramps, nausea, fever):

If yes, please list the medications:

If yes, please provide the name and dosage:

If yes, please describe:

If yes, please describe:

If yes, which ones and were they effective?

I have been informed about the potential side effects and interactions of the prescribed medication for Traveller's Diarrhoea.

I agree to consult with my healthcare provider before starting any new medication. 

I understand that the information provided in this assessment will be reviewed by a licensed pharmacist before my order is processed. 

I consent to my personal and medical information being used to assess my suitability for the prescribed medication.

I understand that my information will be kept confidential and used solely for the purpose of this assessment. 

I confirm that the information provided in this assessment is accurate and complete to the best of my knowledge.

I understand that providing false information may result in my order being cancelled and may have health implications.