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Anti-nausea Questionaire
To ensure your provider can safely evaluate your symptoms, we’ll ask a few questions about your health history, medications, and allergies.
Please identify all your current medical conditions
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Please list all your current medications including dosages.
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Please list all of your known allergies.
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Nausea is a common but nonspecific symptom that can accompany a wide range of conditions - from benign, self‑limited issues such as viral gastroenteritis, food poisoning, motion sickness, or medication side effects, to more serious disorders including bowel obstruction, intracranial pressure changes, cardiac ischemia, or metabolic disturbances. While most cases resolve with conservative care and targeted anti‑emetics, certain “red‑flag” features (vomit containing blood or coffee‑ground material, sudden severe abdominal pain, stiff neck or high fever with headache, new confusion or severe dizziness, or rapid clinical worsening, inability to keep down fluids, scant urine output, signs of dehydration) may indicate a potentially serious underlying process requiring urgent in‑person assessment. If you develop any of these warning signs or your symptoms escalate quickly despite initial treatment, seek immediate evaluation by a qualified healthcare provider or emergency department.
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Read the following for more information about this product and its potential side effects:

It is not safe to take these medications while pregnant or breastfeeding. The FDA advises that these medications may pose a risk to a developing fetus. Oral contraceptives alone may not be effective, as the medication can reduce their effectiveness. The FDA specifically recommends continuing oral contraception alongside a barrier method (like condoms) for the first month after starting a weight loss medication and for the first month after any dose increase. Alternatively, you can switch to a non-oral contraceptive method (such as an IUD or implant) before beginning the medication.
After stopping the medication, you should continue using a backup method, such as condoms, for two months to ensure the medication has fully cleared your system before trying to conceive. Additionally, its safety during breastfeeding is unknown, so if you are nursing, consult your doctor to explore safer weight loss options.
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What is your height?
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What is your weight in pounds
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Your Symptoms

How long have you been experiencing nausea during this specific episode?
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Your Symptoms

What triggered your current nausea episode in your opinion? (Select all that apply)
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Which medication do you suspect is causing this reaction?
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Continue 82
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Tell us about your other cause of your nausea
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Your Symptoms

Safety is our number one priority for you. Do you have any of these “red‑flag” symptoms today?
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Current Medications

Do you take any of the following medications?
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What other information or questions do you have for the doctor?
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Consent:

You have reported experiencing nausea and/or vomiting, conditions that can significantly affect your comfort, daily activities, and overall quality of life. Ondansetron (Zofran) is a medication commonly prescribed to help prevent or relieve these symptoms by blocking certain chemical receptors in the body responsible for inducing nausea and vomiting.

The use of ondansetron may:
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  • Reduce or prevent episodes of nausea and vomiting
  • Improve comfort and quality of life
  • Help you maintain proper nutrition and hydration

While ondansetron is generally well-tolerated, possible side effects may include:
 
  • Headache
  • Constipation
  • Dizziness or lightheadedness
  • Fatigue or drowsiness
  • Dry mouth
  • Rare but serious side effects such as changes in heart rhythm (including QT prolongation) or severe allergic reactions (rash, itching, swelling)

You may need to avoid ondansetron or use it with caution if you:
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  • Have a known heart rhythm disorder, such as congenital long QT syndrome
  • Are currently taking other medications that can affect the heart’s rhythm or serotonin levels
  • Have a history of severe allergic reactions to ondansetron or similar medications

Alternative treatment options for nausea and vomiting include:
 
  • Dietary modifications (small, frequent meals; avoiding triggers)
  • Ginger (such as ginger tea or candies)
  • Acupressure or acupuncture
  • Other prescription or over-the-counter anti-nausea medications
  • Behavioral techniques (relaxation exercises, controlled breathing)

I understand the potential benefits, risks, and possible side effects of using ondansetron. I have been informed about alternative treatment options. I agree to inform my healthcare provider of any side effects or adverse reactions I may experience. I understand that this consent is voluntary and that I can withdraw from treatment at any time.

By selecting below, I consent to the use of ondansetron for the treatment of my nausea and/or vomiting.
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Based on the information you provided, this visit type requires in-person medical evaluation for safe and appropriate care.

What you were seeking help for:

• Anti-nausea

Why this happens

Some symptoms, medical history details, or risk factors mean a condition can’t be safely managed through telemedicine. A licensed provider must examine you in person to ensure the right diagnosis and treatment.
Please visit a local urgent care, primary care clinic, or emergency department if your symptoms worsen.

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