Vitamin B12 injection

1. I understand the questions above and have answered honestly. I understand that any inaccurate or false information could potentially be dangerous to my health and safety.
2. The medication that is prescribed is for my personal use only. I understand the side effects and effectiveness of the treatments.
3. I agree to the Terms & Conditions of this platform.
4. I am 18 years or older.
5. I am currently living in South Africa.
6. Vitamin B12 injections need to be administered by a trained healthcare professional.
7. Please note that ID verification is required for all patients
   
8. I acknowledge that a doctor will communicate with me via WhatsApp within 24 hours.
   
9. I confirm that the contact information I have provided is correct and belongs to me. I understand that the platform relies on this information to communicate private healthcare information with me.

Consent:

• Purpose of treatment: Vitamin B12 injection for the treatment or prevention of Vitamin B12 deficiency and/or Pernicious anaemia.

• How to use: Vitamin B12 is administered by intramuscular injection, usually in the arm or buttock, by a trained healthcare professional.

• Possible Side Effects:

Common / Mild

• Pain, redness, or swelling at the injection site
• Mild diarrhoea
• Itching or mild skin rash

Rare but serious (seek urgent care)

• Severe allergic reaction (rash, swelling, difficulty breathing)
• Low potassium levels (may cause weakness, muscle cramps, irregular heartbeat)
• Dizziness or fainting after injection

• Always read the medication leaflet for full instructions and possible side effects.

Submitting this questionnaire with any “⛔ (do not proceed)” conditions will disqualify you from receiving a prescription.

⛔Please urgently visit your nearest emergency dept or in-person doctor if you are experiencing symptoms such as severe pain, chest pain, difficulty breathing, allergic reactions, dizziness, weakness, or other severe symptoms. Telemedicine services are not suitable for emergency medical conditions. 

If you require an invoice for medical aid, please fill out the below

Submitting this clinical form with any “⛔ (do not proceed)” conditions will disqualify you from receiving a prescription.

Please urgently visit your nearest emergency dept or in-person doctor if you are experiencing symptoms such as severe pain, chest pain, difficulty breathing, allergic reactions, dizziness, weakness, or other severe symptoms. Telemedicine services are not suitable for emergency medical conditions.