Pharmacy Health Declaration

This questionnaire is private and confidential. It can only be viewed by our Registered Nomad Pharmacist. The purpose of the questionnaire is to ensure that your ordered pharmacy item is safe for you to use.

If any queries arise from your answers, the pharmacist may need to contact you before the items can be despatched.

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Introduction

This is a Health Questionnaire that needs to be completed by anyone purchasing certain kits and medicines for Nomad. This includes:

Medical kits containing medicines that can only be purchased from a pharmacy eg Overlander, Raleigh, Jungle & Mountain
Antibiotics used in travel health eg New Independent or Diarrhoea Treatment Packs
Antimalarial medicines

It is your responsibility to answer the following questions so that our pharmacist and prescribers can properly identify if the medication is suitable for yourself and the trip you are undertaking

I have read this statement and agree

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	Pharmacy Health Declaration This questionnaire is private and confidential. It can only be viewed by our Registered Nomad Pharmacist. The purpose of the questionnaire is to ensure that your ordered pharmacy item is safe for you to use. If any queries arise from your answers, the pharmacist may need to contact you before the items can be despatched. 0% Introduction This is a Health Questionnaire that needs to be completed by anyone purchasing certain kits and medicines for Nomad. This includes: Medical kits containing medicines that can only be purchased from a pharmacy eg Overlander, Raleigh, Jungle & Mountain Antibiotics used in travel health eg New Independent or Diarrhoea Treatment Packs Antimalarial medicines It is your responsibility to answer the following questions so that our pharmacist and prescribers can properly identify if the medication is suitable for yourself and the trip you are undertaking I have read this statement and agree 0%