Pharmacy First - Sore Throat - The Family Chemist

1. Please provide the patient's details:

First Name *

Last Name *

Date of Birth *

Gender *

Email Address:

Postcode:

Phone Number:

Consent to Access Your Summary Care Records?

2. Please select which symptoms you're experiencing (select all that apply):

Pain or discomfort especially when swallowing

Fever/high temperature in the last 24 hours

Scratchy or dry throat

No cough or cold symptoms

Symptoms started less than 3 days ago

White spots on my tonsils or the back of my throat

Swollen tonsils

None of the above

2b. You may not be experiencing signs of an infective sore throat, please contact your GP or a local pharmacy for review of your symptoms.

Thank you

We appreciate the time spent answering this questionnaire.

Your symptoms may need further investigation and we are unable to provide treatment through Pharmacy First, please visit your GP or contact NHS 111 for further advice and support.

3. Please select if any of the below symptoms apply:

I am pregnant (and under the age of 16)

I am currently on medication that dampens down my immune system

I have had my tonsils removed

I have experienced unexplained weight loss

I have tried oral medication for this episode of sore throat already but it hasn't helped

I have had persistent mouth ulcers or a lump in my neck

None of the above

3b. Your symptoms may need further investigation and we are unable to provide treatment through Pharmacy First, please visit your GP or contact NHS 111 for further advice and support.

Thank you

We appreciate the time spent answering this questionnaire.

Your symptoms may need further investigation and we are unable to provide treatment through Pharmacy First, please visit your GP or contact NHS 111 for further advice and support.

4. Please select if any of the below symptoms apply (these might suggest that further review of your symptoms are required and we may signpost you to a suitable healthcare provider following our consultation):

Generally feeling unwell/ tired

Breathing faster than usual or difficulty breathing/ shortness of breath

Experiencing a noisy or high-pitched sound when breathing in (stridor)

Unable to swallow solid foods (dysphagia)

Unable to swallow fluids or my own saliva (drooling)

Feeling very dehydrated (with a very dry or sticky mouth)

Rapid or worsening symptoms such as nausea, vomiting or confusion

I am currently on medication that dampens down my immune system and my symptoms have gotten worse in the past day

None of the above

4b. Please select a suitable date and time to book your appointment for a video consultation on the next page. If you start feeling worse before the consultation, seek more urgent care.

Please book a priority consultation

Please follow the link below to book a priority consultation

Please note we will be able to tell you more and answer any questions during the consultation.

5. I can confirm that I have answered the questions to the best of my ability and I am experiencing the symptoms I have selected:

Yes

5b. Please select a suitable date and time to book your appointment for a video consultation on the next page. If you start feeling worse before the consultation, seek more urgent care.

We need to speak with you

We have gathered enough information

Please use the link below to go book an video call consultation about your conditions, please note we will be able to tell you more and answer any questions during the consultation.

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Pharmacy First – Sore Throat

0115 850 1944

enquiries@thefamilychemist.co.uk

Unit 1, Wilford Business Park,
Ruddington Lane,
Nottingham,
NG11 7EP

Opening times

Today’s Responsible Pharmacist

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