♂ Patient - Adrenaline Pen Treatment

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What medication are you looking to get a prescription for? *

Requesting an adrenaline pen because? *

For what period of time have you been taking this medication? *

Who prescribed your last prescription for this medication? *

Have you met with your GP in the last 12 months to discuss your current medication? *

Have you ever had any of the following? *

Have you been diagnosed with anaphylaxis? *

Do you have any problems with your liver or kidneys? *

Do you understand that the eClinic online prescribing service can not help you if you're experiencing anaphylaxis now? *

Have you been shown by a healthcare professional how to us an adrenaline auto injector safely and correctly? *

Are you currently taking any of the following medications or treatments? *

Do you have any of the following health conditions or problems? *

Do you know that: Adrenaline injections come with instructions on how to administer them in the patient information leaflet. You should read this thoroughly before you take any medication. However, if you aren't sure on what to do, you should ring your GP surgery to book an appointment with a nurse practitioner or doctor so that they can show you how to self-administer safely. It's also a good idea to have your close friends and family learn how to administer the injection in the event that you can't. *