Cold Sores

Has a certified medical practitioner diagnosed you with cold sores?
If not, what makes you think you could be having cold sores?

Yes

No

Does any of these describe you?
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

Yes

No

Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.

Yes

No

If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option

Presently Pregnant

Presently Breastfeeding

Planning on getting pregnant

Neither Pregnant nor Breastfeeding

What's your gender?

Male

Female

Transmale (Born a female)

Transfemale (Born a male)

Can you relate to any of the following statements?
You have or have had stomach or duodenal ulcers, as well as stomach or intestinal bleeding in the past.
Your doctor has ever told you that your kidney function is less than 100 percent.
You have previously suffered a terrible reaction to aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs).
You want to use Ibuprofen Gel on skin that is fractured, injured, diseased, or infected.

Yes

No

Are you on any of the following medication?
Antibiotics.
Antihistamines such as stemizole or terfenadine.
Cisapride for stomach discomfort.
Quinidine for circulatory problems.
Pimozide for schizophrenia.

Yes

No

Were there any negative side effects as a result of using this Aciclovir?

Yes

No

Do you have a history of using Aciclovir tablets to cure a herpes infection?
If so, how successful were they?
If not, what treatment did you employ to get rid of your previous outbreak?

Yes

No

Are you willing to visit your doctor if:
Your symptoms are becoming more severe.
After seven days of medication, the symptoms have not improved.
Continuous rectal bleeding, dark or sticky feces, stomach pain, or sudden weight loss are all symptoms you're experiencing.

Yes

No

Can you relate to any of the following symptoms?
Inside the eye, there is pain.
Vision impairment.
One eye is the only one that is afflicted.

Yes

No

Has a certified medical practitioner diagnosed you with a weakened immune system or HIV?

Yes

No

Is it possible for you to attach a photo of your cold sore(s).
This question is not mandatory

Only .jpg, .jpeg, .png, and .gif formats are allowed.

Are there any additional symptoms besides:
Before the outbreak, you may experience tingling, itching, or burning sensations around your lips.
Small, fluid-filled ulcers, most often on the lower lip's margins.
Do you require assistance?

Yes

No

Are these sores only found on your mouth and lips?
If 'Not please specify the additional areas that are affected.

Yes

No

Can we share this information with your General practitioner?
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.

Yes

No

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