PrEP – Pre-Exposure Prophylaxis

1. I understand the questions above and have answered honestly. 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 (including potential liver and kidney damage) and effectiveness of the treatments.
3. I am 18 years or older.
4. I will have an in-person medical consultation at least once a year for comprehensive care and physical examination.
5. I understand that PrEP does not offer 100% protection against HIV.
6. I understand that PrEP does not offer any protection against STIs. 
7. I understand that PrEP needs to be used for a minimum of 7 days before it can adequately protect against HIV infection.
8. I will have kidney function tests done annually if I am 50 years or older. 
9. I will have HIV testing done every 3 months.
10. I will have regular blood-sugar testing.
11. PrEP is given as a 3 month prescription.
12. I acknowledge that a doctor will communicate with me via WhatsApp within 24 hours.
13. Please note that ID verification is required for all patients

Consent:

• Pre-exposure prophylaxis, commonly known as PrEP, is a medical strategy for preventing HIV infection in individuals who do not have HIV but are at high risk of contracting it due to regular exposure (e.g. regular unprotected sex with a sexual partner that has HIV).

• • As a PrEP user, you need to have HIV testing done every 3 months. 
  • You also need kidney function blood tests done once a year if you have diabetes and/or hypertension. 

• Side effects:

• • • Most people tolerate PrEP well, but mild side effects like nausea, headache, or stomach discomfort can occur, especially when starting the medication. These usually resolve within a few weeks.
    • PrEP can also cause more serious side effects affecting the liver, kidneys or bones (osteopenia). If you experience persistent side effects, please stop the medication and seek urgent medical care.

• Please note: 

• If you are not on PrEP and have been exposed to HIV, you will need PEP (post-exposure prophylaxis) and not PrEP.

• • PrEP can reduce the risk of HIV transmission by over 99% when taken as prescribed.
  • PrEP does not offer any protection against STIs. 
  • PrEP needs to be used for a minimum of 7 days before it can adequately protect against HIV infection.
  • If you test positive for HIV, PrEP is not enough. You will need to switch to a full HIV treatment regimen.
  • This service is not meant to replace regular reviews and monitoring with your GP or local clinic. This service is only for patients currently using PrEP. It is not for starting a new user on PrEP.

• 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, prolonged erection (>4 hours), chest pain, difficulty breathing, allergic reactions, dizziness, visual disturbances, 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.