Atrovent

£16.99 – £34.99

Completion of the Medical History questionnaire for this product is mandatory and your purchase is subject to checks by our team.

Strength
Package Size	Clear

Have you seen your GP about your condition? *
What diagnosis was given for your condition? *
Do you give the prescriber permission to contact your GP should an issue arise? *
Enter the practice/surgery you are registered to: *
Are you currently taking any medication prescribed by a doctor, purchased over the counter or homeopathic? *
Which medication, what strength and how often were you taking it? *
Do you suffer from any allergies? *
What allergies do you have and what are the symptoms you experience from an allergic reaction? *
Provide a history of your symptoms, how and when it started, and how it affects your normal daily activities. *
Height (ft) *
Weight (kg) *

Asthma
I confirm that my blood pressure is within the range 140/90 to 90/60. * We can't supply you with this medication if your blood pressure is not within this range. Please consult your GP for more information.
I confirm I have never suffered from a stroke or heart attack. * We can't supply you with this medication if you suffered from a stroke or heart attack. Please consult your GP.
I confirm I have not suffered from any heart, liver or kidney problems * We can't supply you with this medication if you have suffered from any heart, liver or kidney problems. Please consult your GP.
Please provide the name and dosage of any inhalers you currently use. *
Which condition do you use your inhaler(s) for? *
Have you ever been admitted to hospital due to asthma or another respiratory problem? *
Has your asthma symptoms caused difficulty sleeping? *
Do you have your usual asthma symptoms (wheeze, chest tightness, and cough) during the day? *
Does your asthma interfere with your usual activities? *
Do you suffer from diabetes, pheochromocytoma, an overactive thyroid gland, an infection of the lungs or low levels of calcium in your blood? *
I agree to review my inhaler use with my GP at least once a year. * We can't supply you with this medication if you don't agree to this.