Your Health
The information you provide us is treated with absolute confidentiality and will be reviewed by our experienced UK prescribers. We ask the following questions to provide the prescriber with an appropriate level of information to make an informed decision on whether the treatment is suitable or not.
What is your gender?
Please provide more detail.
Do you need help completing this questionnaire?
Please contact us on 020 7157 9759 or email [email protected] and we can assist you.
Do you believe that you have the capacity to make decisions about your own healthcare?
Sorry we can't offer you this treatment, please contact your GP.
Have you been diagnosed with any medical conditions?
Are you currently taking any medication? This includes prescription-only, over-the-counter and homeopathic medicines.
Do you suffer from any allergies?
Please provide details including which allergies and what symptoms you experience.
Is there anything else you would like to include to allow our prescriber to prescribe responsibly?
Medical Questions
Are you requesting treatment for Impetigo?
Are you requesting treatment for Eczema and/or Psoriasis?
Please describe the symptoms you are experiencing
Does the rash consist of vesicles which weep and form yellow/brown crusts?
Please provide more information below.
Is the rash limited to a few lesions on one area of the body?
Please state the exact area which is affected.
Note: entering just "face" will result in your assessment being rejected or delayed. You have to provide as much detail as possible.
Is the affected area inside the nostril?
Have you been treated for Impetigo within the last 3 months?
Please provide more information.
We would strongly advise that you upload a photo of your skin condition as this will prevent delays in your order being dispatched, especially if:
*(Optional Question however uploading an image will aid in getting your order to you quicker as it will allow for a clearer idea of suitability of your the treatment)*
Are there other skin conditions in the same area?
Please provide more information
Have you previously been diagnosed with Eczema or Psoriasis by a healthcare professional?
Are you currently experiencing a flareup in your Eczema or Psoriasis?
Does this incident of Eczema/ Psoriasis differ in any way to when it has been previously diagnosed?
Which parts of your body require treatment with this product?
Please describe the area that requires treatment, including the location on the body and appearance.
How long have you suffered from Eczema or Psoriasis?
Have you used any other creams or ointments to treat the same skin condition?
If "Yes" please tell us what they were and if they were effective or not.
Do you regularly moisturise your skin (especially areas that are likely to be dry or cracked)?
If "Yes" please tell us what other creams you use or have used previously.
Did you know that you should routinely moisturise patches of eczema up to four times daily using an emollient cream or ointment.
You should be aware that you must see a doctor about new rashes, worsening rashes and rashes not responding to treatment.
Consent
Would you like us to notify your GP of the treatment you chose to order today?
Please provide details.
It is very important that your GP is aware of all the medication you are taking, so that you are receiving the best possible care. You should only select “no” if you are completely sure you do not wish us to tell your GP.
Do you agree to the following:
If treatment is not suitable, you will be fully refunded and signposted to another point of care. The decision about the treatment is for both the patient and the prescriber to consider, however, the final decision will always lie with the prescriber.
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