To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.

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If not, please explain why you need this treatment

Male
Female
Transmale (Born a female)
Transfemale (Born a male)


Do any of the following apply:
You are allergic or hypersensitive to Clindamycin
You have used Dalacin or taken Clindamycin before and suffered serious side effects
You are using Dalacin to treat an infection other than bacterial vaginosis
You have a disorder of the nervous system
You have inflammatory bowel disease (such as Crohn's disease or ulcerative colitis)

Please select your option
Presently Pregnant
Presently Breastfeeding
Planning on getting pregnant
Neither Pregnant nor Breastfeeding

Please provide more information of the medication being used if any.

You have an underlying medical condition
You've been through a major surgical procedure
You have allergic reactions
You have cardiovascular conditions or might have had suffered a stroke
You suffer from a low liver or kidney function

Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.

You can select more than one option
Do you require assistance?
Fishy odor that is unappealing
Discharge of a thin liquid
A lumpy & thick discharge
Temperatures higher than 38 degrees
Urinary discomfort
Flu like symptoms

After treatment, your symptoms increase or do not improve.
You're expecting a child.
You believe you have a STI.
If you have pelvic inflammatory disease, you may notice the following symptoms:
Ache in the lower abdomen or around the pelvic
During sex, there is discomfort or pain deep inside the pelvis.

Between periods and after sex, there is bleeding.

Unpleasant smelling discharge might also be caused by a retained tampon.

Please select your option
Do you require assistance?
I've been examined by a doctor
I underwent a self-analysis
It's the first time I've ever had it diagnosed.

Do you require assistance?

Please select your option
Not at all
Less severe abdominal discomfort
Abdominal pain that is tolerable
Extreme abdominal discomfort

Consider the following scenario:
Has your pain become untolarable to the point where it interferes with your ability to perform your obligations?
Is there an urgency for you to keep using pain relievers?
Is it possible that the agony has caused you to vomit?
Is it drastically different from what you're used to?

Consider the following scenario:
Have you seen your doctor to find out what's causing your recurring infections?
What was the source of your recurring infections?

Please select your option
Never
Slight bleeding
Intolerable and repeated loss of blood

Consider the following scenario:
Have you discussed this with your doctor? What advice have they given?
How long has this been a problem for you?
Was it an issue before you started experiencing Bacterial Vaginosis (BV) symptoms, or was it a problem before you started experiencing BV symptoms?


This is a copper contraceptive device usually

In the last two months, you have had UNPROTECTED sex with a NEW PARTNER.
You now have a sexually transmitted infection (STI)

Antibiotics.
Antihistamines such as stemizole or terfenadine.
Cisapride for stomach discomfort.
Quinidine for circulatory problems.
Pimozide for schizophrenia.



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You will read the patient information leaflet supplied with your medication
You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
The treatment is solely for your own use
You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.
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