P Line Consultation MedPro

About the Condition

This form is designed to help us safely and effectively dispense your medicine. Please answer truthfully.

Is this medication for yourself?
If this is not for yourself, please can you tell us who it is for and their age. e.g. grandmother (79yrs old)

Yes

What symptoms/signs do you currently have?

Please click the options on the right side.

Patch of skin that are dry and covered in scales

Patch of skin look pink or red and scales white or silvery

Itching

Burning

Soreness

Cracked skin that may bleed

Other - please specify in the next question

How long have you suffered from these symptoms?

Are you taking any medications?

Yes

Have you tried any other medicines to treat the condition already?
If so, please provide more information.

Yes