Consultation - Chemist 69

Eczema and Dermatitis

Eczema and Dermatitis are skin conditions that result in redness, itchiness, and inflammation in certain areas of the skin. Eczema is a form of dermatitis and often occurs as a result of allergens and irritants such as pollen, dust, detergents, or certain foods, and can be a genetic predisposition. Cold weather can also trigger the condition. Moisturising, avoiding triggers, and using topical corticosteroids or other medications can reduce inflammation.

Please fill out the form below so that our clinicians can determine if the treatment will be suitable for you to take.

1 About Your Health

Your health and safety are our top priorities. Please provide accurate and complete information during your consultation so we can recommend the most appropriate treatment for you.

Question 1:What is your date of birth?

Question 2:What is your gender?

Female

Male

Question 3:Do you have any known allergies?

Question 4:Do you have any chronic conditions? (e.g., diabetes, hypertension, asthma, etc.)

If yes, please detail them here, otherwise please type N/A

Question 5:Are you currently taking any medications?

If yes, please detail them here, otherwise please type N/A

Question 6:Have you had any surgeries in the past year?

If yes, please detail them here, otherwise please type N/A

Question 7:Do you smoke?

Question 8:Do you consume alcohol?

If yes, how much a day/weekly?

Question 9:What is your typical diet like? (e.g., balanced, high-fat, spicy foods)

Question 10:How often do you exercise? (e.g., daily, weekly, rarely, never)

2 About Your Condition

Please provide accurate and honest details during your consultation. This helps us offer the safest and most effective treatment for you.

Question 1:Have you been diagnosed with eczema by a healthcare professional?

Please provide more information here

Question 2:Have you had any tests to confirm the diagnosis? (e.g., skin biopsy, allergy testing)

Please provide more detail here

Question 3:What type of eczema do you have? (e.g., atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis, stasis dermatitis)

Please provide more information here

Question 4:What symptoms are you currently experiencing? (e.g., itching, redness, swelling, dryness, cracking, oozing, crusting)

Please provide more information here

Question 5:How long have you been experiencing these symptoms?

Please provide more information here

Question 6:Are there specific triggers that worsen your symptoms? (e.g., certain fabrics, soaps, stress, allergens)

Question 7:Have you been prescribed medication for eczema before?

Question 8:Are you currently taking any medication for eczema?

Question 9:Have you experienced any side effects from your current or past eczema medications?

Question 10:Have you tried any non-medication treatments for eczema? (e.g., moisturizing, avoiding triggers, using hypoallergenic products)

Question 11:Have you used over-the-counter treatments for eczema?

3 The Agreement and Consent

Please read the Agreement and Consent statements carefully during your consultation. They contain important information to help you stay informed and safe throughout your treatment.

Question 1:Understanding of Risks

Yes

Question 2:Medical Guidance

Yes

Question 3:Consent to Share Information

Yes

Question 4:Confirmation

Yes

1 About Your Health
2 About Your Condition
3 The Agreement and Consent

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Assessment for Eczema

Eczema and Dermatitis

1 About Your Health

Question 1:What is your date of birth?

Question 2:What is your gender?

Question 3:Do you have any known allergies?

Yes

Question 4:Do you have any chronic conditions? (e.g., diabetes, hypertension, asthma, etc.)

Yes

Question 5:Are you currently taking any medications?

Yes

Question 6:Have you had any surgeries in the past year?

Yes

Question 7:Do you smoke?

Yes

Question 8:Do you consume alcohol?

Yes

Question 9:What is your typical diet like? (e.g., balanced, high-fat, spicy foods)

Yes

Question 10:How often do you exercise? (e.g., daily, weekly, rarely, never)

Yes

2 About Your Condition

Question 1:Have you been diagnosed with eczema by a healthcare professional?

Yes

Question 2:Have you had any tests to confirm the diagnosis? (e.g., skin biopsy, allergy testing)

Yes

Question 3:What type of eczema do you have? (e.g., atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis, stasis dermatitis)

Question 4:What symptoms are you currently experiencing? (e.g., itching, redness, swelling, dryness, cracking, oozing, crusting)

Question 5:How long have you been experiencing these symptoms?

Question 6:Are there specific triggers that worsen your symptoms? (e.g., certain fabrics, soaps, stress, allergens)

Yes

Question 7:Have you been prescribed medication for eczema before?

Yes

Question 8:Are you currently taking any medication for eczema?

Yes

Question 9:Have you experienced any side effects from your current or past eczema medications?

Yes

Question 10:Have you tried any non-medication treatments for eczema? (e.g., moisturizing, avoiding triggers, using hypoallergenic products)

Yes

Question 11:Have you used over-the-counter treatments for eczema?

Yes

3 The Agreement and Consent

Question 1:Understanding of Risks

Question 2:Medical Guidance

Question 3:Consent to Share Information

Question 4:Confirmation

Assessment Progress

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