Choose your Location

What is your date of birth?

Do you experience face pain, problems breathing from the nose, and nasal discharge?

STOP HERE if you do not have sinus infection symptoms. We only evaluate for sinus infections.

YesNo

When did you start getting sick?

Less than 1 week agoMore than 1 week ago, but less than 2 weeks (8 to 14 days)15 days or more

Do you have thick, yellow-green nasal discharge?

Blow yellowish or greenish mucusBlow clear mucus

For how many days?

With this illness, do you have difficulty breathing through your nose?

YesNo

Do over-the-counter decongestants make you feel better?

YesNo

Do you….?

Smoke cigarettes or other tobacco productsHave allergic rhinitisHave asthmaNone apply

Have you had the following?

No improvement, despite being on antibiotics for 3 days for this sinus infection.Feel like the sinus infection is coming back, though you have just finished antibiotics within the past 2 weeksAntibiotic use in the past month to treat something unrelated to a sinus infectionSinus symptoms that have lasted longer than 4 weeks4 or more sinus infections over the past yearRecent facial trauma or surgeryRecent hospitalization over the past weekNone apply

Are you allergic to any medicines? Milk protein? Aspirin, NSAIDs, or phenylalanine?

YesNo

Please list your drug allergies and what happens when you use that drug.

Do you take other medication(s) or have any other medical conditions?

Include vitamins, herbs, and over-the-counter products, like pain relievers and sleep aids and WHY you are taking them.

YesNo

In order for us to provide you with the best care, please let us know what medications you take and what conditions you have.

Anything else you would like us to know?

How would you like to pay?

Out of pocketInsurance upload emirates insurance details (if available) Upload a Photo of your Emirates ID Upload Front Upload Back

Billing and delivery details

Google MapDelivery Location Google Map: (Please Share your Google Map Link) Delivery Location Neighborhood/Area: Street Name/No: Address Details:

Personal Details

Title: First Name: Last Name: Mobile Number: E-mail:

Confirm Request and Agree to Terms

After you submit your request, a licensed medical provider will review your information. You will be notified by email/contact number when that provider has reviewed your request and, if appropriate, made care recommendations.

Sinus Infection Survey

Sinus Infection

Choose your Location

What is your date of birth?

Do you experience face pain, problems breathing from the nose, and nasal discharge?

Do you experience any of the following symptoms?

When did you start getting sick?

Do you have thick, yellow-green nasal discharge?

With this illness, do you have difficulty breathing through your nose?

Do over-the-counter decongestants make you feel better?

Do you….?

Have you had the following?

Do you have any of the following symptoms?

Are you allergic to any medicines? Milk protein? Aspirin, NSAIDs, or phenylalanine?

Do you take other medication(s) or have any other medical conditions?

Do you have any of these conditions?

Anything else you would like us to know?

How would you like to pay?

Billing and delivery details

Personal Details

Confirm Request and Agree to Terms

Get in Touch

Al Thiqa Al Dowaliah Pharmacy

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