Assessment

Have you been diagnosed with chronic plaque psoriasis by your GP or dermatologist?

Have you been prescribed any of the below before?

Please provide more information

Are you ordering this treatment to treat a current flare-up of your psoriasis?

Please provide more information

When did you start experiencing this flare-up?

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Is this flare-up different from your previous psoriasis flare-ups?

Were your previous treatments mentioned above by you effective at treating previous flare-ups?

How many flare-ups have you had in the past 12 months?

Which of these best describes your psoriasis?

Please describe your symptoms

On which parts of your body are you experiencing symptoms?

Please provide more information.

Do you have any other symptoms? For example, feeling generally unwell, widespread psoriasis, a high temperature, unexpected weight loss, joint pain or stiffness.

Please provide more information

Apart from psoriasis, do you have any other medical conditions or illnesses? For example, problems with calcium levels in your body?

Please provide more information

Are you taking any prescription, over the counter, or herbal medication?

Please provide more information

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

Please provide more information

Are you currently pregnant, planning to become pregnant or breastfeeding?

Please provide more information

Please enter your date of birth

Do you confirm that you will:

• Avoid use on more than 30% of your body or using more than 15 grams per day
• Avoid using under a bathing cap, bandages or dressings as it increases the absorption of the steroid
• Avoid use on large areas of damaged skin, on mucous membranes, or in skin folds (groin, armpits, under
• breasts) as it increases the absorption of the steroid
• Avoid use on your face or genitals (sex organs) as they are very sensitive to steroids
• Avoid excessive sunbathing, excessive use of solarium and other forms of light treatment

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