Consultation - Chemist 69

Acid Reflux

The human gut contains billions of bacteria, most of which are beneficial to our digestive and immune systems. They help us to digest our food, absorb nutrients, metabolise drugs, prevent inflammation, and provide a barrier to disease-causing pathogens into the body. These ‘good’ bacteria balance out the more toxic and damaging bacteria which are also present in the gut. Sometimes this balance may be lost (such as after a course of antibiotics), causing a range of symptoms. Knowing your gut type, taking probiotics and making dietary changes are steps you can take to maintain a healthy gut bacteria balance.

1 About Your Health

Your health and safety are our top priorities. Please provide accurate and complete information during your consultation so we can recommend the most appropriate treatment for you.

Question 1:What is your date of birth?

Question 2:What is your gender?

Female

Male

Question 3:Do you have any known allergies?

If yes, please detail them here, otherwise please type N/A

Question 4:Do you have any chronic conditions? (e.g., diabetes, hypertension, asthma, etc.)

If yes, please detail them here, otherwise please type N/A

Question 5:Are you currently taking any medications?

If yes, please detail them here, otherwise please type N/A

Question 6:Have you had any surgeries in the past year?

If yes, please detail them here, otherwise please type N/A

Question 7:Do you smoke?

Question 8:Do you consume alcohol?

If yes, how much a day/weekly?

Question 9:What is your typical diet like? (e.g., balanced, high-fat, spicy foods)

Question 10:How often do you exercise? (e.g., daily, weekly, rarely, never)

2 About Your Condition

Please provide accurate and honest details during your consultation. This helps us offer the safest and most effective treatment for you.

Question 1:Who diagnosed your acid reflux? (e.g., gastroenterologist, general practitioner)

Please provide more detail here

Question 2:How long have you been experiencing acid reflux symptoms?

Question 3:Have you had any recent tests to evaluate your condition? (e.g., endoscopy, pH monitoring)

Question 4:How often do you experience acid reflux symptoms? (e.g., daily, weekly, occasionally)

Daily

Weekly

Occasionally

Question 5:What are the common symptoms you experience? (e.g., heartburn, regurgitation, chest pain, difficulty swallowing)

Question 6:Are your symptoms worse at certain times of the day or after certain activities? (e.g., after eating, lying down)

Question 7:Have you been prescribed medication for acid reflux before?

Question 8:Are you currently taking any medication for acid reflux?

Question 9:Have you experienced any side effects from your current or past acid reflux medications?

Question 10:Have you tried any non-medication treatments for acid reflux? (e.g., dietary changes, elevating the head of your bed, weight loss)

Question 11:Have you consulted with a healthcare provider about your acid reflux?

3 The Agreement and Consent

Please read the Agreement and Consent statements carefully during your consultation. They contain important information to help you stay informed and safe throughout your treatment.

Question 1:Understanding of Risks

Yes

Question 2:Medical Guidance

Yes

Question 3:Consent to Share Information

Yes

Question 4:Confirmation

Yes

1 About Your Health
2 About Your Condition
3 The Agreement and Consent

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Acid Reflux

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Asthma

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HRT

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Weight Loss

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Assessment for Acid Reflux

Acid Reflux

1 About Your Health

Question 1:What is your date of birth?

Question 2:What is your gender?

Question 3:Do you have any known allergies?

Yes

Question 4:Do you have any chronic conditions? (e.g., diabetes, hypertension, asthma, etc.)

Yes

Question 5:Are you currently taking any medications?

Yes

Question 6:Have you had any surgeries in the past year?

Yes

Question 7:Do you smoke?

Yes

Question 8:Do you consume alcohol?

Yes

Question 9:What is your typical diet like? (e.g., balanced, high-fat, spicy foods)

Yes

Question 10:How often do you exercise? (e.g., daily, weekly, rarely, never)

Yes

2 About Your Condition

Question 1:Who diagnosed your acid reflux? (e.g., gastroenterologist, general practitioner)

Question 2:How long have you been experiencing acid reflux symptoms?

Question 3:Have you had any recent tests to evaluate your condition? (e.g., endoscopy, pH monitoring)

Yes

Question 4:How often do you experience acid reflux symptoms? (e.g., daily, weekly, occasionally)

Question 5:What are the common symptoms you experience? (e.g., heartburn, regurgitation, chest pain, difficulty swallowing)

Question 6:Are your symptoms worse at certain times of the day or after certain activities? (e.g., after eating, lying down)

Yes

Question 7:Have you been prescribed medication for acid reflux before?

Yes

Question 8:Are you currently taking any medication for acid reflux?

Yes

Question 9:Have you experienced any side effects from your current or past acid reflux medications?

Yes

Question 10:Have you tried any non-medication treatments for acid reflux? (e.g., dietary changes, elevating the head of your bed, weight loss)

Yes

Question 11:Have you consulted with a healthcare provider about your acid reflux?

Yes

3 The Agreement and Consent

Question 1:Understanding of Risks

Question 2:Medical Guidance

Question 3:Consent to Share Information

Question 4:Confirmation

Assessment Progress

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