Psoriasis TreatmentPsoriasis Treatment PrescriptionWe want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.Name* Name*What age are you?* What age are you?*Your Email* Your Email*Pharmacy to where prescriptions should be sent. Pharmacy to where prescriptions should be sent.What is your birth sex?* What is your birth sex?*MaleFemaleOtherHave you received a psoriasis diagnosis from a GP or skin specialist? Have you received a psoriasis diagnosis from a GP or skin specialist?YesNoPlease confirm why you are looking for treatment?* Please confirm why you are looking for treatment?*I need medication to manage a flare-up I would like to try an alternative treatment for psoriasisI am requesting treatment for the first time I would like help to manage chronic symptoms of psoriasisHow would you describe your psoriasis?* How would you describe your psoriasis?*Small red dots scattered all over the skinThin scaling which covers your entire body, your skin could feel painful and hotBlisters on your skin, or skin oozing in patchesThick and scaly patches on your skinJust on my hands and feetPlease share where you are experiencing these symptoms(Select all that apply)* Please share where you are experiencing these symptoms(Select all that apply)*Face and neckFeet and legsScalp Hands and armsTorso Buttocks Groin and genitalsBackOtherWould you say that your psoriasis is across more than 5% of your body?* Would you say that your psoriasis is across more than 5% of your body?*YesNoNot sureAside from your current skin condition symptoms, do you currently have any of the options below?* Aside from your current skin condition symptoms, do you currently have any of the options below?*Unintentional weight loss Feeling unwellFever and high temperature Stiff, swollen or painful jointsNone of these apply to meWhat treatments are you currently using for psoriasis ?* What treatments are you currently using for psoriasis ?*Betnovate DiprosalicDovobet or Enstilar EumovateHydrocortisone OtherI am not using any treatment at the momentWhat treatments have you used in the past for psoriasis?* What treatments have you used in the past for psoriasis?*Betnovate DiprosalicDovobet or Enstilar EumovateHydrocortisone OtherI am not using any treatment at the momentAside from psoriasis, please confirm if you have had any previous medical illness or conditions or surgeries?* Aside from psoriasis, please confirm if you have had any previous medical illness or conditions or surgeries?*Yes I haveNo I have notPlease share if you are currently taking any prescription or over-the-counter medications, or are currently using recreational drugs? Please share if you are currently taking any prescription or over-the-counter medications, or are currently using recreational drugs?YesNoDo you currently have any allergies?* Do you currently have any allergies?*YesNoDo you believe certain cases of psoriasis (plaque) requires you to moisturise daily along with any other treatment you receive? Do you believe certain cases of psoriasis (plaque) requires you to moisturise daily along with any other treatment you receive?YesNoIs there anything else you would like to share before we finish? Is there anything else you would like to share before we finish?YesNoIt is advised that we tell your GP about any treatment we provide to you. Would you like DrClinic to share any information regarding this treatment with your GP? It is advised that we tell your GP about any treatment we provide to you. Would you like DrClinic to share any information regarding this treatment with your GP?YesNoI can confirm that I have answered all the questions honestly and to the best of my knowledge. This treatment is just for my own self use. There are side effects with treatments, and I understand these. If I would like to know about alternative treatment options, I can book a video appointment and discuss with a DrClinic GP.* I can confirm that I have answered all the questions honestly and to the best of my knowledge. This treatment is just for my own self use. There are side effects with treatments, and I understand these. If I would like to know about alternative treatment options, I can book a video appointment and discuss with a DrClinic GP.*I confirmUpload photo of the affected area* Upload photo of the affected area*Add fileThis type of file isn't allowedThe file size must be up to 5 MBTotal Amount: 20 €
