About Your Health
To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.
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Are you aware that Hydrocortisone Cream should not be used to treat the following skin conditions:
Acne or rosacea
Do you have a history of using Betnovate Scalp Application to treat the same problem?
If you do, how successful was it?
Are you aware that Betnovate should not be used to treat any of the following skin problems:
Acne.
Did you know that Betnovate cream for the face or the front of the neck is not available?
Do you have a history of using (Betnovate) cream/ointment to treat the same problem?
If you do, when was this and how successful was it?
Are you aware that Betamethasone with Neomycin Cream should not be used to treat the following skin conditions:
Acne or rosacea
Do you have a history of using Betamethasone with Neomycin Cream cream to treat the same problem?
If you do, when was this and how successful was it?
Are you aware that Betamethasone Clioquinol Cream should not be used to treat the following skin conditions:
Acne or rosacea
Does your eczema/dermatitis display any of the following infection symptoms?
Redness.
Do you have a history of using Betamethasone with Clioquinol cream to treat the same problem?
If you do, when was this and how successful was it?
Are you aware that betamethasone should not be used to treat any of the following skin problems:
Acne.
Do you have a history of using clobetasone (Eumovate) cream/ointment to treat the same problem?
If you do, when was this and how successful was it?If 'Yes' - Was it effective and how long ago was it?
Do you have a history of using Elocon Scalp Lotion to treat the same problem?
If you have, when was it and how successful was it?
Are you the actual consumer of this medicine?
If not, please describe in detail who the intended consumer is and how old he/she is.
Do you have a history of using Hydrocortisone Cream to treat the same problem?
If you do, when was this and how successful was it?
Are you aware that Fucidin H Cream should not be used to treat the following skin conditions:
Acne or rosacea
Do you have a history of using Fucidin H cream to treat the same problem?
If you do, when was this and how successful was it?
Do you have a history of using Fucidin Cream to treat the same problem?
If you do, when was this and how successful was it?
Are you aware that Fucibet Cream should not be used to treat the following skin conditions:
Acne or rosacea
Did you know that Fucibet Cream for the face or the front of the neck is not available?
Do you have a history of using Fucibet cream to treat the same problem?
If you do, when was this and how successful was it?
Has the target user tried a different medicine to address the symptoms before?
If yes, what medicine was consumed and how effective was it?
For how long has the consumer of this medicine experienced these symptoms?
Please select your option
What symptoms do you intend to treat using this medicine?
Please provide more information
Did you know that betamethasone cream for the face or the front of the neck is not available?
Do you have a history of using betamethasone (Betnovate) cream/ointment to treat the same problem?
If you do, when was this and how successful was it?
Do you moisturize your skin frequently particularly the body parts that are prone to dryness and/or crackin)?
If you do, please tell us about any other lotions or ointments you currently use or have used.
Did you know that:
A healthcare practitioner should assess any acute injuries.
Do you have a nut allergy particularly to coconut?
Coconut oil can be found in Betacap.
Are you aware that Betacap Scalp Application can cause a fire when handled without caution?
After using Betnovate Scalp, do not use a hair dryer or smoke.
Do you have a history of using Betacap Scalp Application to treat the same problem?
If you do, how successful was it?
Did you know that that new rashes, worsening rashes, and rashes that don't respond to treatment require urgent medical attention?
Do you require assistance?
For which duration have you suffered from scalp condition
Kindly select your option
Do you intend to use this lotion only on dry, itchy, flaky, or irritated scalp skin?
If not, please explain where you intend to use the product
Do you mind sharing an image of your scalp condition.
A photograph will assist our healthcare team in making an informed decision about your treatment and will allow us to provide you with any additional information that may be required.
Is there any difference in the occurrence of your ailment now compared to when it was first diagnosed?
If there is, kindly describe the changes
Have you seen a doctor about your scalp problem?
If you havent, what gives you the assurance that this treatment is suita ble for you?
Can you relate to any of the following statements?
You have or have had stomach or duodenal ulcers, as well as stomach or intestinal bleeding in the past.
What is your biological gender?
Please select your option
Date of Birth
Use the calendar to select your date of birth.
Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924
If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option
Do you have a history of using other ointments or lotions to manage your condition?
If so, please describe them and whether or not they were successful.
For which duration have you been experiencing eczema/dermatitis
Kindly select your option
Our team strongly advise you to include a photo of your skin issue.
This will help you avoid delays in receiving your order, especially if:
Kindly describe which specific parts of your body require this product's treatment?
kindly provide the specific details describing the exact area, including and how it looks.
Is there any difference in the incidence of eczema/dermatitis now compared to when it was first diagnosed?
Do you require assistance?
Have you seen a doctor about your eczema/dermatitis?
Do you require assistance?
Do you have a flare-up of your eczema or dermatitis right now?
Do you require assistance?
Can we share this information with your General practitioner?
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advise you share this treatment with your doctor for him/her to update your medical records.
Can you relate to any of the following?
You have an underlying medical condition
Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.
Do you have a bad case of dandruff on your head right now?
Submit
