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      Condition Questions

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      General Health Questions

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      Photo Upload

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      Terms & Conditions

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    Condition Questions

    Have you had this problem diagnosed by a healthcare professional before?

    YesNoOther

    Why do you need treatment today?

    I’ve had this problem before and need a REPEAT prescriptionI’ve had this problem before but want to try a NEW medicationI’ve NOT had this problem before and want to try a medication to helpOther

    What are you planning on using this treatment for? Please select the option that best matches your skin problem (if you are unsure please select ‘I don’t know’)

    Eczema/Atopic Dermatitis
    -Red, itchy, and inflamed patches of skin, often found on the hands, elbows, behind the knees, face or scalp. The skin may become dry, cracked, or thickened.

    Psoriasis
    -Thick, red patches of skin covered with silvery-white scales. Often affects the scalp, elbows, knees, and lower back. Patches may be itchy or sore.

    Contact Dermatitis
    -A red, itchy rash caused by contact with an allergen or irritant (e.g., soaps, cleaning products, or metals). The rash may be accompanied by blisters or dry, cracked skin

    Seborrheic Dermatitis
    -Scaly (flakey), greasy patches on the scalp, face (especially around the nose and eyebrows), or chest. Often associated with dandruff or an oily appearance.

    Skin fold rash (Intertrigo)
    -Irritation and inflammation in skin folds (e.g., under the breasts, armpits, groin), often caused by moisture, friction, and heat. It may appear as red, raw, and sometimes weeping skin

    Perioral Dermatitis
    -Red bumps, a rash, or dry patches around the mouth, nose, or eyes. The skin may feel tight or irritated, and the condition is often mistaken for acne. Especially common in women aged 16-45 and often linked to use of steroid creams or cosmetics.

    Bacterial Skin Infection
    -Infected skin that is red, swollen, and may produce pus. Common signs include warmth, pain, and a crusted or weeping area of the skin. Examples include infected eczema or impetigo

    Other

    I don’t know

    Where on your body is the problem? Please select all that apply

    Head and NeckUpper BodyLower BodyOther

    Head and Neck

    ScalpFaceEarsEyebrowsEyelidsMouth

    Scalp

    All over scalpFrontBackSidesNape (back of neck where hair starts)Several PatchesOne Patches

    Face

    ForeheadBoth CheeksLeft CheekRight CheekNoseJaw lineChinCentre of face (down the middle)

    Ears

    Outside earInside earBehind earEar lobeLeft earRight earBoth ears

    Eyebrows

    BothLeftRightSingle patchMultiple patchesAll over

    Eyelids

    All overPatchSingle spotLeft eyelidRight eyelidBoth eyelids

    Mouth

    Around the moutCorner(s) of mouth

    Upper Body

    ChestBackUpper ArmsForearmsElbowsBreastsArmpitsStomach/AbdomenHandsFinger Nails

    Chest

    Entire chestLeft sideRight sideIn Between Breasts

    Back

    UpperMiddleLowerAll over

    Upper Arms

    InsideOutsideLeft armRight armBoth arms

    Forearms

    InsideOutsideAll aroundLeft armRight armBoth arms

    Elbows

    Inside elbow foldOutside elbow surfaceLeftRight

    Breasts

    Underneath both breasts (in the skin folds)Underneath one breast (in the skin fold)Side(s)TopBottomIn between breasts

    Armpits

    Left armpitRight armpitBoth armpits

    Stomach/ Abdomen

    StomachLower AbdomenBelly ButtonAll over

    Hands

    TopPalmLeft handRight handBoth hands

    Finger Nails

    ThumbIndex fingerMiddle fingerRing fingerLittle fingerLeft handRight handBoth handsOther

    Lower Body

    GroinThighsLower LegsKneesFeetToesToe Nails

    Groin

    Left groinRight groinBoth groins

    Thighs

    Left thighRight thighBoth thighs

    Lower Legs

    CalfShinLeft legRight legBoth legs

    Knees

    Behind KneesOutside knee surfaceLeftRight

    Feet

    TopSideSole (underneath)HeeLeft footRight footBoth feet

    Toes

    Big toe2nd toeMiddle toe4th toeLittle toeLeft footRight footBoth feet

    Toe Nails

    Big toe2nd toeMiddle toe4th toeLittle toeLeft footRight footBoth feet

    Other

    GenitalsOtherI don't know

    Due to the sensitive nature of this area- DigiDerm does not treat skin problems related to the genitals. Please visit your NHS GP or local sexual health clinic.

    Do you have any of the following symptoms?

    Itchiness (persistent itching in the affected area)Redness (persistent red areas of skin)Dry skin (dry, rough, or cracked areas)Scaling (flakey or peeling skin)Crusting (scab-like crusts on the skin)Swelling (inflamed or puffy skin)Flushing (sudden redness and warmth of the skin)Papules (small red spots or bumps without pus)Pustules (small pus-filled spots)Blistering (fluid-filled blisters or sores)Scarring (marks or depressions left by healed skin conditions)PainGreasy/ Oily skinWarm to touch (affected skin feels hot)Discharge or oozing (fluid leaking from the skin)Bleeding (open sores or cracked skin)Regular InfectionsRash affecting more than 10% of you body surface (about 10 hand prints worth of skin)Tightness (skin feels tight or uncomfortable)Purple, flat-topped bumpsAltered sensation or feelingExcessive sweating (increased sweating in affected areas)Darkening of skin colour (increase in skin pigmentation)Lightening of skin colour (loss of pigmentation)None of the aboveOtherI don’t know

    Please rate from 1-10 how painful it is (0= no pain, 10= worst imaginable):

    Please tell us more e.g. When was the last infection? How many infections have you had in the last year? Where on your body?

    Altered sensation or feeling

    When did the problems start?

    How quickly did the problem start?

    Suddenly (minutes)Quickly (hours)Gradually (days)Slowly (weeks)Very slowly (months)Over several yearsOtherI don't know

    Is it getting worse?

    NoYesOtherI don’t know

    How does the problem behave?

    It's always thereIt comes and goesOtherI don’t know

    How long does it last?

    MinutesHoursDaysWeeksMonthsYears

    Please explain:

    Have you been unwell in any other way recently or experienced any of the following symptoms?

    No- I have been wellI have been unwell recently due to another condition, illness or circumstanceTemperatureFeverNauseaVomitingNight sweatsWeight lossExcessive tirednessJoint pain/ swellingOther concerning symptomsI don’t know

    Please tell us more about how you've been unwell recently

    Please tell us more about your temperature

    Please tell us more about your fever

    Please tell us more about your nausea

    Please tell us more about your vomiting

    Please tell us more about your night sweats

    Please tell us more about your weight loss

    Please tell us more about your tiredness

    Please tell us more about your joint pain/swelling

    Please tell us more about your other concerning symptoms

    Does anything make it WORSE? Please select all that apply

    Stress or anxietyHeat or sweating (e.g., exercise, hot weather)Dry weather or cold air (e.g., winter conditions)Friction or rubbing (e.g., from clothing or skin folds)Contact with irritants (e.g., soaps, detergents, perfumes)Allergens (e.g., dust mites, pollen, animal dander)Hot showers or bathsUsing harsh skincare products (e.g., strong cleansers or exfoliants)Sun exposureInfections or cuts on the skinOtherNone of the aboveI don’t know

    Does anything make it BETTER? Please select all that apply

    Moisturising regularly (using emollients or moisturisers)Cool or cold compressesAvoiding irritants or allergens (e.g., fragrance-free products)Staying in a cool environment (e.g., avoiding heat and sweating)Gentle cleansing with mild soap substitutesWearing loose-fitting clothing (to avoid friction and heat buildup)Managing stress (e.g., through relaxation techniques)

    OtherNone of the aboveI don’t know

    Have you already tried any of the following treatments?

    Moisturisers
    e.g. CeraVe, Aveeno, E45, Diprobase, Epaderm, Doublebase, Dermol, Oilatum

    Washes/ Soap Substitutes/ Shampoos
    e.g. Dermol, Cerave, E45, Aqueous cream, Oilatum, QV Gentle, Hydromol, Epaderm

    Steroid creams/ointments
    e.g. Hydrocortisone, Eumovate (Clobetasone), Elocon (Mometasone), Betnovate (Betamethasone), Fucibet

    Specialist Eczema treatments
    e.g. Protopic (Tacrolimus) ointment, Elidel (Pimecrolimus) cream

    Specialist Psoriasis treatments
    e.g. Dovonex ointment (Calcipotriol), Dovobet gel/ointment, Enstillar foam

    Antibiotic creams/ gels/ lotions
    e.g. Fucidin, Fucibet, Trimovate

    Antibiotic tablets/capsules
    e.g. Flucloxacillin, Clarithromycin, Erythromycin, Cefalexin, Co-amoxiclav

    Antifungal Creams/Tablets
    e.g. Canesten, Daktarin, Daktacort, Terbinafine tablets, Itraconazole capsules

    Antiviral Creams/Tablets
    e.g. Zovirax (Aciclovir) cream, Aciclovir tablets

    Antihistamines
    e.g. Loratadine, Cetirizine, Fexofenadine

    Steroid tablets, tape or injections
    e.g Prednisolone tablets, Haelen (Fludroxycortide tape), Cortisone injection

    Please write the name (plus dose and length of course if you know it) of any you have tried and how helpful they were.

    Immune Suppressing tablets/injections
    e.g. Methotrexate, Azathioprine, Hydroxychloroquine, Mycophenolate, Ciclosporin

    Biologics
    e.g Humira injection, Remicade injection

    Cosmetic procedures
    e.g. Chemical peels, Micro-needling, Dermal fillers, Botox

    Laser/ Light/UV therapy

    Herbal/ Alternative treatments
    e.g tea tree oil, zinc, vitamins

    Surgical Procedures

    Other

    None - I haven't tried any treatments.

    What is your biological sex?

    FemaleMaleOther

    Trans Female (Male at birth)Trans Male (Female at birth)

    Are you pregnant, breastfeeding or trying for a baby?

    Yes

    No

    Unfortunately, due to safety reasons we would be unable to prescribe any weight loss treatments for you. Please contact your GP for further help.

    Have you ever been diagnosed with any medical conditions?

    AneamiaAnxiety DisorderAsthmaAtrial Fibrillation (AF)Bipolar DisorderCancer (Past or Present)CholecystitisCOPDCrohnsDepressionEczemaEpilepsyFolic acid deficiencyMigraineMyasthenia GravisObsessive-Compulsive DisorderOsteoarthritisOsteoporosisPancreatitisPeripheral Vascular DiseasePsoriasisRaynaud’sRheumatoid Arthritis

    Gastric Reflux DiseaseGastric SleeveHay FeverHeart ArrhythmiaHeart Disease/ Heart AttackHeart FailureHigh Blood PressureHigh CholesterolInflammatory Bowel DiseaseIron deficiencyIrritable Bowel Syndrome (IBS)Kidney DiseaseLiver DiseaseStroke/ TIASurgeryThyroid DisordersType 1 DiabetesType 2 DiabetesUlcerative ColitisVitamin D deficiencySchizophreniaSjorgen’s syndrome

    None of the above

    Other

    Please provide details about your cancer diagnosis:

    Please provide details about any previous or upcoming surgeries:

    Please explain other medical conditions:

    Do you currently take any medications, vaccines, supplements, or recreational drugs?

    NoMedicationsOver the counter medications/ herbal medicationsSupplements

    Recreational drugsVaccinesOther

    Please tell us which medications you are currently taking:

    Please tell us what over-the-counter or herbal medications you are currently taking:

    Please tell us what supplements you are currently taking:

    Please tell us what recreational drugs you are currently using:

    Please tell us if you will be having any vaccines at the same time as using this medication:

    Please tell us what else you take:

    Do you have any allergies to any medications, supplements, herbs, chemicals, peanuts, soya or anything else we should be aware of?

    Yes

    No

    Please tell us more:

    Is there anything else you feel is important for us to know that would prevent us from safely prescribing for you?

    Yes

    No

    Photo Upload

    • If this is a new problem then we require at least one photo of it (max 6 photos) using your phone or digital camera.

    • Take a "far away photo" (from 1 meter away) to show the location and size of the problem.

    • Take a close-up photo (10-12 cm away) to show the details.

    • If appropriate please include a size reference (e.g. a coin or ruler) in your photo for scale.

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    GP Details

    By providing these details, you consent to us sharing relevant information with your GP if necessary for safety purposes, accessing your NHS Summary Care Record, or obtaining further details about your medical history.

    Do you understand and agree with the following?

    You agree that for eczema, dermatitis, psoriasis and other dry skin conditions it is important that in order to prevent flare ups of your condition, you regularly moisturise (3-4 times daily) using an emollient cream or ointment. You understand that you should use a cream or ointment instead of soap to wash your skin.

    You are aware paraffin-containing preparations (emollients/creams/ointments, etc.) can soak into clothing and bedding and cause a fire hazard. You should wash clothing and bedding frequently and avoid smoking and naked flames. You are aware that for any scalp applications, they can be flammable, and it is not recommended to blow-dry your hair after using them.

    You are aware that long-term use of steroid creams, ointments, lotions, and other forms can cause permanent skin damage and skin thinning and should be applied sparingly and not be used continuously. You are aware that steroid creams should not be applied to sensitive areas such as the face, groin, or underarms without specific advice from a healthcare professional, as these areas are more prone to skin thinning and side effects.

    You are aware that Protopic (Tacrolimus) ointment or Elidel (Pimecrolimus) cream should generally not be used continuously without a break, unless directed by a healthcare professional. You are aware that while using these medications, exposure to natural or artificial sunlight (e.g., sunbeds) should be minimised, and sunscreen should be applied if you need to go outside. You are aware that these medications may cause local skin irritation (e.g., burning or stinging) when first applied—this risk can be minimised by applying them on alternate days for the first week. If the irritation persists or worsens, discontinue use and seek medical advice.

    You are aware that prolonged use of topical antibiotics (e.g., Fucidin or Fucidin H) can lead to antibiotic resistance and should only be used for short courses as prescribed by a clinician.

    You are aware that if you are using medicated creams or ointments that contain an antifungal or an antibiotic, you should complete the full course of treatment, even if your symptoms improve, to prevent the infection from coming back.

    You are aware that if your symptoms are not responding to treatment, you develop any worsening, new or severe symptoms, or you have any concerns or psychological distress, then you should see your GP or seek urgent care as soon as possible.

    You will read the patient information leaflet supplied with any medication we send you, and if you have any allergies to any of the ingredients or any contraindications, you will not take the medication and contact a DigiDerm clinician for further advice. You have informed us of any allergies you have by completing the general health questions.

    You have informed us of any current or previous medical conditions you have by completing the general health questions.

    You are not pregnant.

    You agree that if needed, a DigiDerm clinician may contact you via email or telephone in response to this consultation form to offer advice and suggest treatments where necessary, or if they feel they need more information to make an accurate diagnosis or assessment of your condition.

    You agree that if after reviewing your consultation, your skin problem is something we cannot treat or is not suitable for our service, then we will give you a full refund and suggest you visit your registered NHS GP for further advice.

    You are at least 16 years old and currently resident in the UK at the time of this consultation. This treatment is to be used only by you.

    You take responsibility to inform your own regular doctor/NHS GP of this online consultation and any treatments supplied, or any changes in your circumstances.

    The answers provided to the above questions are true and accurate to the best of your knowledge.


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