Female Patients - Application for Hay Fever Treatment

Hay Fever

What causes Hay Fever?
Hay Fever, or allergic rhinitis, is a very common allergic reaction to pollen or other allergens such as dust mites, animal dander (hair/fur) or mould.
This occurs when the allergen is inhaled and the person's immune system is sensitized.

Mild Hay Fever symptoms can be improved through over the counter medication or avoiding exposure to pollen. For more severe symptoms, there are prescription medication alternatives.

To get medically treated for Hay Fever, simply fill out the following short questionnaire. One of our doctors will review and, if medically suitable, they will send you a prescription to treat your Hay Fever.

Please note that some medications used to treat Hay Fever may cause drowsiness and this medication may affect the performance of skilled tasks such as driving or cycling. It should be avoided in those operating heavy machinery.

You may be unsuitable for this medication if you have a past history of liver disease, kidney disease, urinary retention or if you have ever had an adverse reaction to antihistamines.


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Have you been diagnosed with Hay Fever? *

How long have you suffered with Hay Fever? *

Please select the symptoms that you experience (you can select multiple) *

How long has this current episode been troubling you? *

What treatments have you used for Hay Fever? *

Are you looking for a specific treatment? *

Have you been to see a Doctor about this matter? *

Are you aware there is a small chance that antihistamine tablets can cause drowsiness and impair driving? *


Do you suffer from Asthma? *

Have you allergies to medicines or tablets? *

Are you breastfeeding?

Are you pregnant?

Are you currently taking any prescribed medications? *

Are you currently taking any non-prescribed medications, vitamin supplements, over the counter or herbal remedies? *

Are you currently taking any recreational drugs? *

Any other medical information relevant to your treatment request that you think our Doctor should consider? *

Do you have any other allergies? *

Has your allergy been confirmed with a medical test? *


What is your birth sex? *

Can you tell us your current height (enter as centimetres)?

Can you tell us your current weight (enter as kg)?

Do you know your most recent blood pressure reading?

Do you smoke? *

Do you ever drink alcohol - weekly consumption (1 unit = 125ml wine, ½ pint beer)? *

Do you confirm that you have read and understood this and your answers are fully correct and true? *

Please confirm that this medication, if prescribed, is for your use only. *