Assessment

Have you been diagnosed with dry skin or eczema by your GP or dermatologist?

What symptoms do you have at the moment?

Is this episode of eczema different in any way to when it was first diagnosed?

Please provide more information below

How long have you had eczema

Are you aware you should refer to your GP or dermatologist about:

• Rashes that don't respond to treatment
• Rashes that are worsening
• New or unfamiliar rashes

Which treatment creams have you previously been prescribed by your GP / dermatologist?

Please provide more information

How often do you use your steroid cream / ointment?

Are you using any moisturisers/emollients?

What symptoms/signs do you currently have? Please provide details, including the appearance of the skin.

What areas of the body are currently affected?

Do you currently have signs of a skin infection? This includes fluid oozing from the skin, yellow crust on the skin, swollen and sore skin, and fever. This NHS page contains more information on skin infections.

Please provide more information below

Please enter your date of birth

Are you currently taking any prescription-only medicines, alternative medicines or recreational drugs?

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Do you have any known allergies to any medicines or substances?

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Are you pregnant or planning to become pregnant or breastfeeding?

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• I understand that long term use and/or overuse of steroid creams can cause serious irreversible side effects
• I understand that steroid creams should not be applied to the face, neck or any sensitive areas of skin
• I understand that I should not apply steroid creams under a bandage (unless advised to do so by a doctor)
• I understand that I should see my doctor for regular reviews of my steroid creams
• I understand that I should see my doctor if there is no improvement, or a worsening of the condition, after 14 days of using the cream
• I understand that certain creams and emollients can be flammable and I should keep away from fire, flames and cigarettes when using these products

I understand that I should not use steroid creams to treat the following skin problems:

• Skin infections (unless used with an antibiotic)
• Acne
• Rosacea
• Itchy skin without inflammation

We strongly advise that you inform your GP of any medication you receive.

Would you like us to inform your GP of medication you receive from Rightdose?

Please enter your:

• Full Name
• Date of Birth
• Your registered home address with your GP

Please enter your:

• GP Surgery Name
• GP Surgery Address
• GP Surgery Email
• GP Surgery Contact Number

I confirm:

• I am over 18 years old
• The medicine ordered is for my sole use only
• I take responsibility to inform my own regular doctor of the online assessment or any changes in my circumstances
• I will read the patient information leaflet supplied with the medicine specifically the side effects and dosages
• I have answered all the questions truthfully
• I agree to the Rightdose online pharmacy privacy policy and terms and conditions