About Your Health
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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Do you have bacterial vaginosis at the moment?
If not, please explain why you need this treatment
Date of Birth
Use the calendar to select your date of birth.
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Do you have a history of using Dalacin to manage your Bv and succeeded in clearing it?
Can you relate to any of the folowing?
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)
If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option
Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.
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
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 advise you share this treatment with your doctor for him/her to update your medical records.
Kindly identify some of the signs and symptoms you are presently experiencing
You can select more than one option
Do you require assistance?
Do you conscent to seeking further medical assistance should the following happen?
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.
Do you think a retained tampon be the source of your symptoms?
Unpleasant smelling discharge might also be caused by a retained tampon.
What makes you certain that your symptoms are those of BV?
Please select your option
Do you require assistance?
Have the symptoms you experience about your bv changed or are they still the same?
Do you require assistance?
Do you experience discomfort in the abdomen?
Please select your option
Please provide us with more information about the severity of your pain
- Has your pain become intolerable to the point where it interferes with your ability to perform your obligations? - Is there an urgency for you to keep using pain relievers? - Has the pain caused you to vomit? - Is the pain different from what you're used to?
Kindly inform us about your medical history and issue so that our medical experts can assist you?
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?
Have you suffered any vaginal bleeding?
Please select your option
Can you tell us more about your bleeding between periods? How frequent or substantial is itso we can help?
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?
Have you experienced Bv at least four times in the past year?
Do you have an IUD device?
This is a copper contraceptive device usually
Which of the following statements applies to you:
In the last two months, you have had UNPROTECTED sex with a NEW PARTNER.
You now have a sexually transmitted infection (STI)
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.
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