Answer seven quick questions about your general health to get the most effective clinically proven treatments for you.

DO YOU AGREE AND CONSENT TO THE FOLLOWING?

I live in Australia or New Zealand.
I shall be the sole user of any medication offered to me through this service.
I confirm all answers are provided by me, and will be truthful.
I agree to the terms and conditions.

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Please provide your sex at birth*

KeyA

Male
Key B

Female

Has a Doctor previously diagnosed you with (Herpes Sim-plex Virus)?*

KeyA

Yes
Key B

No

Do you know what type of HSV you have?*

Key A

HSV 1
KeyB

HSV 2

Are you having an out break at the moment?

KeyA

Yes
Key B

No

How often do you have outbreaks in 12 months Period?*

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Have you used Antiviral Medication before to manage outbreaks?

KeyA

Yes
Key B

No

What medications have you used before to manage outbreaks?*

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Did you have a good result from treatment?

KeyA

Yes
Key B

No

Did you experience any side effects?

KeyA

Yes
Key B

No

What side effects did you experience?*

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Are you currently taking any medication?

KeyA

Yes
Key B

No

What medication are you currently taking?*

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Do you have any allergies?

KeyA

Yes
Key B

No

What allergies do you have?*

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Do you have any medical conditions or a history of prior surgeries?

KeyA

Yes
Key B

No

What are your medical conditions and history of prior surgeries?*

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Is there anything else you want your Doctor to know about your condition or health?

KeyA

Yes
Key B

No

What would you like to tell your Doctor?*

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Is there any chance that you are Pregnant?

KeyA

Yes
Key B

No

Would you like to have the medication for treatment of your current symptoms or for prevention of future flare up?*

KeyA

CURRENT SYMPTIONS
Key B

FUTURE FLARE UP

Can you confirm that the information you have given is true and accurate, that this medication is solely for yourself, and that if prescribed the medication, you will review the information supplied regarding the medication and side effects.

KeyA

Yes
Key B

No

Please enter your date of birth. *

Day

Month

Year

Please use this format (DD/MM/YYYY)

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Discretion is at the heart of what we do but for legal reasons the name on your prescription must be your full legal name. Please provide your legal name as per your official government ID. *

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Based on your medical history and individual needs, our doctors have provided personalised treatment. Please complete your mobile phone number to view recommended treatment. *

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Do you have a Medicare card?

KeyA

Yes
Key B

No

Please enter your Medicare Card details

IRN

card number

Month

Year

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What is your IHI?

Your IHI is located next to your Covid vaccine certificate. If you are an international student or working visa holder, for our doctors to write a prescription, you first need to register for myGov and an IHI (Individual Health Identifier). You can do this all online within minutes. Please take a look at the Services Australia website for complete instructions, click here.

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Unfortunately based on your answer you would not be suitable for treatment. If you would like to speak with the Burst doctor to discuss other treatment options, please book an appointment here.

If you made a mistake, you can go back and correct your answer.

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Please follow this link to book a $35 consultation with our doctor:

Click here to book If you made a mistake, you can go back and correct your answer.

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Thank you for filling out the form.

It has been sent to our doctor for review.

Confirmation Required

Answer seven quick questions about your general health to get the most effective clinically proven treatments for you.

Please provide your sex at birth*

Has a Doctor previously diagnosed you with (Herpes Sim-plex Virus)?*

Do you know what type of HSV you have?*

Are you having an out break at the moment?

How often do you have outbreaks in 12 months Period?*

Have you used Antiviral Medication before to manage outbreaks?

What medications have you used before to manage outbreaks?*

Did you have a good result from treatment?

Did you experience any side effects?

What side effects did you experience?*

Are you currently taking any medication?

What medication are you currently taking?*

Do you have any allergies?

What allergies do you have?*

Do you have any medical conditions or a history of prior surgeries?

What are your medical conditions and history of prior surgeries?*

Is there anything else you want your Doctor to know about your condition or health?

What would you like to tell your Doctor?*

Is there any chance that you are Pregnant?

Would you like to have the medication for treatment of your current symptoms or for prevention of future flare up?*

Can you confirm that the information you have given is true and accurate, that this medication is solely for yourself, and that if prescribed the medication, you will review the information supplied regarding the medication and side effects.

Please enter your date of birth. *

Discretion is at the heart of what we do but for legal reasons the name on your prescription must be your full legal name. Please provide your legal name as per your official government ID. *

Based on your medical history and individual needs, our doctors have provided personalised treatment. Please complete your mobile phone number to view recommended treatment. *

Do you have a Medicare card?

Please enter your Medicare Card details

What is your IHI?

Unfortunately based on your answer you would not be suitable for treatment. If you would like to speak with the Burst doctor to discuss other treatment options, please book an appointment here.

Please follow this link to book a $35 consultation with our doctor:

Thank you for filling out the form.