Form - Yeast Fluconazole

You're just a few questions away from Yeast Infection relief!

Please fill this questionnaire to complete your order.

Please enter your first name:

Please enter your last name:

Please enter your email:

What was your sex assigned at birth?

Male

Female

How old are you?

Select the situations and conditions that apply to you.

If ANY of the following apply, our doctors may NOT be able to give you a prescription. In these cases, we recommend seeing a physician. You can book a phone consultation with an OB on our shop page.

Please select all of the following symptoms that apply to you.

Discharge: Thick, White, Cottage Cheese-like

Itching, Burning, Irritation, or Inflammation of Vagina

None of the above

How long have you experienced these symptoms?

When was your last menstrual cycle?

Please list down any known allergies.

Thank you for filling the form!

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