0%


Male
Female
Transgender (Male to Female)
Transgender (Female to Male)




0%


If yes, please describe your symptoms.


If yes, please list the conditions.


If yes, please list your current medications.


If yes, list all your allergies.





0%




- I have read and understood the patient information leaflet for Acetazolamide.

- I understand the potential side effects and risks associated with Acetazolamide.

- I confirm that the information I have provided is accurate and complete.

- I agree to contact my GP or the prescribing service if I experience any adverse effects or changes in my health.

- I consent to the use of this information for the purpose of prescribing Acetazolamide for altitude sickness.