Malaria Protection

Please state your gender

This refers to your biological gender

Male

Female

Date of Birth

Use the calendar to select your date of birth.

Kindly make a list of all the malaria-risk nations or places you plan to visit during your trip.
Do you require assistance?

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

Yes

No

Please provide more information of the medication being used if any.
Yes/ No

Yes

No

Please select your option
Male
Female
Transmale ( Born a female)
Transfemale ( Born a male)

Male

Female

Transmale (Born a female)

Transfemale (Born a male)

Have you ever been given the following diagnosis by a doctor:
Depression
Epilepsy, convulsions, or fits
Renal impairment/kidney disease
Hepatic impairment/liver disease
Tuberculosis

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

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
Sweats and chills
Headaches
Vomiting
Muscle aches
Diarrhoea
Do you require assistance?

Yes

No

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.
Orders placed by the same account will be reimbursed.

Yes

No

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?

Yes

No

For which duration do you intend on staying in the malaria-affected area?
Kindly provide more details

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

Yes

No

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