Pharmacy First Sore Throat Questionnaire NHS Pharmacy First - Sore Throat Pre-Consultation QuestionnaireNHS Pharmacy First ServiceSore Throat Pre-Consultation Assessment (Ages 5 and over). This form helps our pharmacist prepare for your consultation. It does not replace a clinical assessment, diagnose your condition, or guarantee prescription of antibiotics.1. Urgent Safety Screening (Red Flags)Please review these critical symptoms carefully before proceeding.Do you, or the patient, have any of the following urgent symptoms? Breathing difficulties or severe shortness of breath Drooling or completely unable to swallow fluids or saliva Severe neck swelling, stiffness, or inability to open the mouth (trismus) Confusion, severe drowsiness, or slurred speech A rash that does not fade when a glass is pressed firmly against it (non-blanching rash) Rapidly worsening illness None of the above2. Patient DetailsPlease provide details of the patient requiring the consultation.First NameLast NamePatient Date of BirthNHS Number (Optional)Contact Phone NumberEmail AddressAddressAddress Line 1Address Line 2CityPostcodeParent or Guardian Name (If patient is under 16)3. Symptoms & Clinical InformationPlease describe the patient's current symptoms.How long has the sore throat been present?- Select Duration -1-3 days4-7 daysMore than 1 weekSore Throat Pain Severity0Is the patient able to swallow fluids or saliva? Yes, swallowing normally Swallowing is painful but still possible No, completely unable to swallowWhich of the following symptoms are present? (Select all that apply) Fever (temperature above 38°C / 100.4°F) Swollen or tender neck glands Tonsil redness or swelling White spots or pus on the tonsils Cough Runny nose or nasal congestion Hoarse voice New body rash4. Medical History & BackgroundImportant safety and background questions.Is the patient currently pregnant or breastfeeding? Yes No Not ApplicableDoes the patient have a weakened immune system? Yes NoDoes the patient have a history of recurrent tonsillitis? Yes NoOther Medical ConditionsCurrent Regular MedicinesAllergies and Drug ReactionsTreatments Tried So Far5. Consultation Booking & ConsentFinal steps to submit your pre-consultation form.When are you available for a consultation today?- Select Availability -As soon as possible / ImmediateMorning (9am - 12pm)Afternoon (12pm - 5pm)Evening (5pm - 8pm) I confirm the information provided is accurate. I do consent to assessment and GP notification where appropriate. I understand this questionnaire must be reviewed before my appointment request can be accepted.Submit Form
