Dulcolax Pico Liquid 100ml (A) (P)

Regular price: £3.49
Regular price: ~~£3.99~~
Sale price: £3.49

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Questions from our Pharmacist

As this is a Pharmacy Medicine, we need to ask you a few questions. These will help our Pharmacist ensure the product is right for you.

Dulcolax Pico Liquid 100ml (A) (P)

Patient details

Q1: Is the medicine just for you?
Yes
No

Please give details of the person you are purchasing this for and why This field is mandatory

Q2: Have you used this medication before?
Yes
No

If so, have you been advised to take this by your GP? This field is mandatory

How many days are you taking this medicine? This field is mandatory

Q3: What is the age, in years, of the youngest intended customer of this product? Please give in months if younger than 1 year.

Years This field is mandatory

Months This field is mandatory

Q4: What symptoms will the product be used to treat? This field is mandatory

Q5: How long have the symptoms been present?

Days This field is mandatory

Other medication

Q6: Is the intended customer(s) taking any other medication, including vitamins and herbal remedies?
Yes
No

Please specify This field is mandatory

Medical conditions

Q7: Does the intended customer(s) live with any other medical conditions (e.g. diabetes, asthma)?
Yes
No

Please specify This field is mandatory

Consent

I confirm that I have read the information in this questionnaire and will follow the advice shown here and in the product leaflet. This field is mandatory

Description