IMA Private Registrations

Tamiflu is supplied in boxes of 10 capsules.
Tamiflu can be used as a treatment for Pandemic Influenza (either immediately after the start of symptoms or after exposure to a person who has the disease). In this case one box is all that is necessary; 2 capsules are taken daily for 5 days.
NB the course must be completed.
Tamiflu can also be use as a prophylactic measure. In this case 1 capsule is taken every day for 40 days. 4 boxes need to be ordered. Please make clear how many boxes are being requested for each individual for whom the drug is to be prescribed.

Private Individual Registration for Tamiflu prescription. Please enter your details in the boxes provided below. Click the "Preview" button to check your details, then make sure that you click the "Submit" button once you have finished. Fields marked with * are mandatory and must be completed.
First Name *
Last Name *
Address *
Valid Post Code
Telephone No. *
Email *
Date of Birth *
Are you registered with a General Practitioner (GP) ? *
GP Details : Please use the boxes below to enter your GP's details
Name
Address
Town/City
County
Post Code
Telephone
Q1. Are you allergic to Tamiflu or any of its ingredients ? Please answer Yes/No *
Q2a. Are you allergic to any other medicines ? Please answer Yes/No *
Q2b. If yes, please describe drug and reaction. If no please enter not applicable. *
Q3. I would like the opportunity to discuss a relevant medical issue with a doctor before a prescription is issued. Please answer Yes/No *
Q4. Have you been diagnosed with a severe kidney disease ? Please answer Yes/No *
Q5. If female are you pregnant ? Yes/No/Not appropriate *
Please indicate number of boxes required - 1 or 4 (if required as a prophylactic). *
I have read, and agree to abide by the terms and conditions. Yes/No *
Click HERE to view Terms & Conditions


First Name *
Last Name *
Address *
Valid Post Code
Telephone No. *
Email *
Date of Birth *
Are you registered with a General Practitioner (GP) ? *

Name
Address
Town/City
County
Post Code
Telephone
Q1. Are you allergic to Tamiflu or any of its ingredients ? Please answer Yes/No *
Q2a. Are you allergic to any other medicines ? Please answer Yes/No *
Q2b. If yes, please describe drug and reaction. If no please enter not applicable. *
Q3. I would like the opportunity to discuss a relevant medical issue with a doctor before a prescription is issued. Please answer Yes/No *
Q4. Have you been diagnosed with a severe kidney disease ? Please answer Yes/No *
Q5. If female are you pregnant ? Yes/No/Not appropriate *
Please indicate number of boxes required - 1 or 4 (if required as a prophylactic). *
I have read, and agree to abide by the terms and conditions. Yes/No *

Private client prescriptions must be paid for and collected from the consulting rooms at
39 George Road, Edgbaston, Birmingham B15 1PL.
Alternatively a proforma invoice may be issued which will include p&p and on receipt of payment the prescription will be sent by post.
Click HERE to return