Are you aged between 18 and 65?
Have you been diagnosed by your GP, nurse or pharmacist with cold sores (herpes labialis)?
Do you have any of the following symptoms:
Do you have an allergy (hypersensitivity) to medicines containing Aciclovir or Valciclovir or Famacilovir or Penciclovir?
Are you pregnant, breast feeding or possibly pregnant?
Have you been diagnosed with any of the following conditions?
Are you taking any of the following medications?
Do you understand that outbreak treatment should be initiated at the earliest symptom of a cold sore eg tingling, itching or burning sensation?
Do you understand that if your symptoms are getting worse and the sores have not healed after 10 days you must see your doctor?
Do you agree to the following?