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Consent statements

Declarations and consent

By checking the boxes below and clicking ‘Continue’ I declare that all the information I have provided or confirmed is correct.I also understand and agree to the following:

  • I will need to have a blood test to assess my liver function (LFT) prior to starting treatment and may require a repeat test every 3-12 months.
  • If my liver function tests are abnormal my prescribed medication may need to be changed and/or stopped or I may require more regular blood tests.
  • Taking drugs for pain (e.g. opiates or morphine-like substances including codeine, dihydrocodeine, and tramadol) alongside taking Naltrexone or Nalmefene will cause severe pain, severe withdrawal reaction and may even lead to hospitalisation
  • I understand that a clinician will review this consultation form to determine if this medication is suitable for me before prescribing
  • I agree to Nul sharing my details and responses from this consultation form with our partner Blueco Healthcare so that their clinicians can conduct a clinical assessment and prescribe, dispense, and deliver the medication
  • I agree to Nul sharing my details and responses from this consultation form with our partner Thriva as per our Privacy Policy page. I understand my personal data will be managed in accordance with Thriva’s privacy notice and I agree  that Thriva may disclose my confidential patient information to with Nul
  • I agree to Blueco sharing my details and prescription with a Pharmalogist so that they can dispense and deliver the medication
  • I agree to Thriva, its doctors and labs may process and disclose my confidential health information in order to manage its systems and services and to provide test results, escalations, insights and reports.
  • I consent to the clinicians and pharmacy reviewing my NHS Summary Care Record (SCR) in order to confirm that the medication is suitable for me
  • I am requesting this treatment only for myself and will take the medicine as prescribed and advised by the clinician
  • I will read the Patient Information Leaflet that is supplied with the medication
  • I have answered all the questions accurately and truthfully so that the clinician can make appropriate decisions that are safe for me. I understand that incorrect or false information may put my health at risk
  • I will let Nul or the clinicians know if anything I have told you in this consultation changes, especially if I start taking any new medication and get diagnosed with any new medical conditions
  • I agree to the Terms and Conditions of the service
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