About your Condition
We need to understand more about your specific condition to help find the most suitable medication or advice to help you. Please can you answer the following questions. If you get stuck or need any help, you can contact us.
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Are you looking to access treatment for yourself?
Have you previously been prescribed any medication for this condition by your GP or any other healthcare professional?
Are you or have you experienced any of the following symptoms?
-Regular vomiting -Coughing up blood -Blood in your stools -Feeling that food gets stuck after swallowing -Darker coloured stools than normal -Unexplained weight loss -Difficulties swallowing
How long have you been experiencing symptoms of heartburn/indigestion?
Have you ever been diagnosed with any other medical conditions?
This can include:
-Immune system conditions such as HIV -Liver or kidney issues
Do you suffer with any allergies?
Are you pregnant, planning a pregnancy or breast-feeding at the moment?
Do you currently take any medication? This includes herbal remedies and over the counter medication.
Is there any other information you would like to share with our prescribing team?
If so, please provide more information
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