Fever blisters / Cold sores

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Texas Telemedicine Doctor

Use this form if you have fever blisters which are also called "cold sores" and "herpes labialis"

Last name *

Date of birth *

YYYY

When was the last time you had a fever blister?

More than a 1 year ago

6 months to 1 year

Within the last 6 months

I currently have a fever blister

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How often do you get fever blisters?

More than 6 times a year

3 - 6 times a year

1 - 2 times a year

Less than once a year

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How do you take your fever blister medication?

I only take my medication when I get a sore

I take daily suppressive therapy

I treat outbreaks when they occur, and I take daily suppressive therapy

I only take my medication when a sore occurs, but I am interested in daily suppressive therapy

I don't currently take any medication for fever blisters

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Have you been compliant in taking your medication(s)?

Yes, I always take my medication

Mostly, I sometimes miss a dose but not very often

I forget to take my medication 2 or more times a week

I am not currently taking my medication

I have not been prescribed medication

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Medication side effects - If you are experiencing any symptoms that you think are related to your fever blister medication, please tell me about them. If you are not, enter "None."

Example: I think acyclovir gives me a headache

Do you feel like your current medication regimen controls your fever blisters?

Yes, my symptoms are controlled

I feel like my control could be better

My symptoms are not controlled

Other:

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Is there anything else about your fever blisters that you would like me to know?

Submit

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