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
Have you been diagnosed with Eczema/Psoriasis or dry skin by your GP or dermatologist?
Please provide more information
Are you currently experiencing a flare-up of your eczema or psoriasis?
(a flare-up is where the affected skin becomes dry, red, itchy. inflammed, sore and cracked)
This is usually when the skin loses moisture.
Does this episode of eczema or psoriasis differ in any way to when it was initally diagnosed?
Which parts of your body require treatment with this product?
Please describe the area that needs treatment including it's location on the body and it's appearance.
Are you aware you should refer to your GP or dermatologist about:
How long have you suffered from eczema or psoriasis?
Which treatment creams or ointments have you been prescribed by your GP or dermatologist?
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)*
How often do you use your steroid cream?
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 currently have signs of skin infection?
This includes fluid oozing from the skin, yellow crusts on the skin, swollen and sore skin, and fever.
Do you regularly moisturise your skin (especially areas that are prone to be dry and/or cracked)?
If "Yes" - Please tell us what other creams and ointments you use or have used.
Did you know - you should regularly moisturise patches of eczema or dermatitis (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.
We use cookies to give you the best online experience. By using our website you agree to our use of cookies in accordance with our cookie policy.