Migraine Prescription

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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 65?

Yes No

Are you pregnant, breastfeeding, or possibly pregnant?

Yes No

Are you allergic to Sumatriptan, Rizatriptan, Zolmitriptan or similar triptan medications?

Yes No

Do you have any of the following diagnosed conditions?

Any heart condition, including narrowed arteries (ischaemic heart disease)
Chest pain (angina) or previous heart attack
Stroke or mini-stroke (TIA)
High blood pressure
Coronary artery spasms (e.g. Prinzmetal’s angina)
Abnormal heart rhythm (Wolff-Parkinson-White Syndrome)
Poor circulation (Peripheral Vascular Disease)
Previous damage to the gut or spleen (e.g. infarction)
Inflammation of the colon due to poor blood flow (ischaemic colitis)
Epilepsy or a history of seizures
Liver disease or liver problems
Kidney disease or kidney problems
Allergy to sulphonamide antibiotics (e.g. trimethoprim)
Any serious health condition that could require urgent hospital treatment

Yes No

Medical Condition

Do you experience any of the following during your migraine?

Weakness or heaviness in one side of the body (e.g. arms or legs)
Double vision
Poor coordination or clumsiness
Ringing in the ears (tinnitus)
Feeling faint or losing consciousness
Seizure-like movements (fits)
A new rash appearing alongside your headache
Headache pain mainly at the back of your head
A recent noticeable change in your migraine attacks (e.g. more frequent, more severe, or lasting longer)

Yes No

Do you suffer from migraines more than 10 days per month?

Yes No

Do your migraine attacks follow a consistent pattern each time?

Yes No

Do untreated migraine episodes last fewer than 4 hours or longer than 24 hours?

Yes No

Have you ever been formally diagnosed with migraine and previously found relief from triptan medications like Sumatriptan, Rizatriptan, or Zolmitriptan?

Yes No

Medication

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

Yes No

Are you currently taking any of the following medications?

Ergotamine or Methysergide (migraine treatments)
Any other ‘triptan’ medication taken in the last 24 hours (e.g. naratriptan, rizatriptan, zolmitriptan, almotriptan, eletriptan)
MAO inhibitors taken in the last 2 weeks (e.g. moclobemide, phenelzine, isocarboxazid, tranylcypromine)
SSRIs for depression or anxiety (e.g. citalopram, escitalopram, fluoxetine, sertraline, paroxetine)
SNRIs for depression (e.g. venlafaxine, duloxetine, mirtazapine, dapoxetine)
Other mood-altering medications (e.g. lithium, reboxetine, tryptophan, flupentixol, selegiline)
St John’s Wort (a herbal remedy for low mood)
Cimetidine (used for indigestion or ulcers)
Propranolol (a beta-blocker used for heart or anxiety conditions)
Any antibiotics (must wait at least 72 hours after completing the course)
Antifungal medicines (e.g. ketoconazole, itraconazole)
The combined contraceptive pill (note: the mini-pill is allowed)

Yes No

Agreement

Do you agree to all of the following?

Read patient information leaflet
Use the medication personally only
Inform GP or service if starting new medicines or experiencing side effects
Answered all questions truthfully
Understand prescriber makes final decision

Yes No

Do you understand that if your migraines do not improve or worsen, or not achieve relief after treatment, you must consult your GP?

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)

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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.

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Take photo using camera

Camera required

Upload Previous Prescription

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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.