Please give more information about who the multiple are.
			
			
				Please provide as much information as possible. Including the age, relationship
				to you and whether you have consent to buy on their behalf.
			
			
		 
		
		
			What are the symptoms that this medication will be used for? 
			
				This helps us understand what condition or illness may be causing the symptoms and if they might be caused by
				something more serious that needs review by a Pharmacist or GP.
			
			
			
			How long have these symptoms been present? 
			
				Usually symptoms clear up after some time, however if they have been
				present for a while we may recommend speaking to a Pharmacist or GP
				about them.
			
			
				A few days (1-3 days) 
				Less than 1 week 
				Between 1 and 4 weeks 
				More than 1 month 
				They've been coming and going for the past few weeks or months 
				They aren't present right now 
				Not sure 
			 
			
			Has anything been done or taken for these symptoms? 
			
				This might include seeing a GP or buying something from the supermarket
				or another Pharmacy.
			
			
				No 
				Yes 
			 
			
				Please provide details below
			 
			
				Do you or the person the medication is for take any medications, have any
				conditions, illnesses or allergies?
			 
			
				No 
				Yes 
			 
			
				
					Please include prescription medication, vitamins and supplements. We
					want to make sure the medication you are buying is safe to take and
					won't interact with the other medications or trigger allergies. Please
					also mention any other relevant factors e.g. pregnancy.
				
			 
			
			
			
			
			So we can verify your age and identity please enter your Date of Birth below 
			
				In order to process your order we are required as a Pharmacy to check this information
				using a secure identity check service. If we are unable to verify your identity,
				we may not be able to process your order.
			
			
			Date of Birth