Acid Reflux Prescription

Start Your Consultation

Please enter your email and phone number to continue.

I agree to receive consultation updates by SMS

Do you agree and consent to the following?

You are completing this consultation for yourself and to the best of your knowledge.
You will disclose any medical conditions, serious illnesses or operations you have had.
You will disclose any prescription medications you are currently taking and agree to use only one weight loss treatment at a time.
You agree to our Terms & Conditions, Terms of Sale, and confirm that you have read our Privacy Policy.
Your accurate and honest responses to this online questionnaire for weight loss treatment are crucial. Withholding or providing false information can severely harm your health and may result in life-threatening consequences. By filling out this questionnaire, you confirm that your responses are truthful and accurate, acknowledging the potential risks of misinformation.
You agree to undergo identification and age verification. This may require submitting valid documents to our approved third-party verification partner for validation.
You consent to EveryDayMeds accessing your Summary Care Record (SCR) for the purpose of ensuring the safe supply of treatment. If the SCR is unavailable or incomplete, you agree to participate in appropriate two-way communication (e.g. phone, secure message, or video consultation) to verify your medical history. If you do not respond or engage, your order will be cancelled.

Your Health

Are you aged between 18 and 80?

Yes No

Are you pregnant, breastfeeding or possibly pregnant?

Yes No

Do you have any allergies to proton pump inhibitors (e.g. omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole)?

Yes No

Have you ever developed a ring-shaped or plaque-shaped rash after sunlight exposure while taking a proton pump inhibitor?

Yes No

Have you been diagnosed with any of the following?

Osteoporosis
Liver problems
Gastric cancer
Low magnesium (hypomagnesaemia)

Yes No

Medical Condition

Are you aged over 50 with new or recently changed reflux symptoms?

Yes No

Are you experiencing acid reflux at least twice per week?

Heartburn
Chest pain after eating
Regurgitation
Burning in throat
Food feeling stuck in the middle of the chest or throat

Yes No

Are you experiencing any of the following?

Difficulty swallowing
Unintentional weight loss
Abdominal swelling
Persistent vomiting
Persistent or severe diarrhoea
Vomiting blood
Blood in stools or black, tarry stools
Iron deficiency anaemia
Severe liver disease

Yes No

Medication

Are you currently taking any medications (including prescription, over-the-counter, or recreational drugs)?

Yes No

Are you taking any of the following medications?

NSAIDs (e.g. ibuprofen)
Diazepam
Digoxin
Methotrexate
Warfarin or other blood thinners
Rifampicin
Clarithromycin
St John’s Wort
HIV or Hepatitis C medications
Ulipristal (emergency contraception or fibroids)
Ciclosporin or tacrolimus

Yes No

Agreement

Do you agree to the following?

You will read the patient information leaflet provided with your medication.
You understand this medication is for your personal use only.
You will contact your GP if your condition changes, or if you experience side effects or start new medication.
You have answered all questions truthfully.
You understand the prescriber makes the final decision on treatment based on your responses.

Yes No

Do you understand that this treatment is for short-term use (28 days) for acid reflux / heartburn symptoms only?

Yes No

Do you understand that if your symptoms do not improve after 14 days or persist after 28 days, you must see your GP?

Yes No

Do you understand that healthy lifestyle changes such as eating a balanced diet, reducing alcohol, stopping smoking, and maintaining a healthy weight are also recommended?

Yes No

Do you give us permission to access your NHS Summary Care Record or request medical history from your GP if required?

Yes No

Do you consent to us sharing relevant consultation details with your GP to ensure continuity of care?

Yes No

GP Consultation

We can notify your GP of your treatment for you. To do so, we need their contact information. Sharing this information allows your GP to maintain a comprehensive record of your medical history, which is crucial for your health. Without complete records, there could be potential risks to your well-being.

I consent to EveryDayMeds contacting my GP and share information about my prescription.

Yes No

Practice/GP Name

Practice/GP Address

Identity Verification

Please upload your identification documents.

Would you like to upload documents now?

Upload now Upload later

What you need to upload

To safely prescribe weight-loss medication, our clinicians need to verify your identity and assess your eligibility. Please upload both of the following:

Photo ID

Upload a clear photo of one valid ID document, such as:

Passport
UK driving licence
National ID card

Requirements:

The full document must be visible
Text and photo must be clear and readable
The ID must be valid (not expired)

🪪

Tap to upload ID card

No file chosen

Full-Body Photo

Take a full-body photo of yourself using your camera.

Photo guidelines:

Full body visible (head to feet)
Wear fitted clothing (no coats or baggy clothes)
Stand straight, facing the camera
No filters or edits

This photo is used only to help our clinicians assess your BMI and suitability for treatment.

📸

Take photo using camera

Camera required

Upload Previous Prescription

📄

Upload previous prescription

No file chosen

If you select this option, your order won’t be approved until all required documents are submitted. After your consultation, we’ll email you instructions on how to upload your documents.