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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We'll determine how many pills you'll need based on the number of days you'll be in a malaria-risk location.
Kindly provide more details
Can you relate to the following statement?
Lariam causes an allergic reaction or hypersensitivity in you (mefloquine).
Are you aware that if you develop any of the following symptoms, you should stop taking Lariam immediately and seek medical help:
Should you develop any of these effects, stop taking Lariam and replace it with another malaria-prevention drug right away.
Have you been examined with one or more of the following conditions
Depression, suicidal ideation, or self-destructive behavior
Do you have a history of using Larium?
If you have, were there any negative side effects?
Are you experiencing any of the following problems:
Myasthenia gravis is a kind of myasthenia.
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.
Can you relate to any of the following?
You have an underlying medical condition
Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.
If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option
What is your biological gender?
Please select your option
Date of Birth
Use the calendar to select your date of birth.
Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924
Do you have a history of being diagnosed with the following conditions?
Depression
Are you on any of the following medication?
Antibiotics.
Do you conscent to consulting a medic right away and inform them you've been in a malaria-risk area if you get any of the following symptoms while traveling or within a year of returning?
High-temperature
Did you know that each registered account can only get treatment for one person?
Notably, if a spouse or family member requires therapy, they must create their own account and provide their own email address and medical information.
Have you visited a malaria-endemic country lately?
If so, have you had symptoms like fever, chills, pains, weariness, or headaches since you got back?
For which duration do you intend on staying in the malaria-affected area?
Kindly provide more details
Kindly make a list of all the malaria-risk nations or places you plan to visit during your trip.
Do you require assistance?
Have you ever been given the following diagnosis by a doctor:
Depression
Submit
