About Your Health
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Are you suffering an outbreak of psoriasis presently?
Have you ever applied Enstilar to your scalp?
If you have, when was this and how successful was it?
Are you on any of the following medication?
Antibiotics.
Did you know that we are unable to deliver Enstilar for use on the following parts?
Are you aware that Enstilarshould not be used to treat any of the skin problems listed below:
Psoriasis erythrodermic and pustular
Did you know that?
If your condition does not improve after four weeks, you should consult a doctor.
Date of Birth
Use the calendar to select your date of birth.
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If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option
Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.
Does any of these describe you?
You have an underlying medical condition
Can you relate to any of the following conditions?
Difficulties with Calcium metabolism
Can you relate to any of the following?
You have an underlying medical condition
Did you know that new rashes, worsening rashes, and rashes that don't respond to treatment require further medical attention?
Do you have a fever or a general feeling of unease or illness right now?
Has a certified doctor or qualified medical practitioner examined you with psoriasis?
If not, please explain how you discovered you have psoriasis.
For which duration have you been experiencing psoriasis?
Have you noticed your psoriasis symptoms improving during the summer?
Have your symptoms changed since the last time you saw your doctor?
Kindly explain to us which specific parts of your body require this treatment
Kindly explain the affected area, where exactly on the body it is located and how it looks.
Please include a photo of your psoriasis in your submission.
This step is not mandatory however, it is important for you to answer especially if:
Do you have a history of using coal tar to treat psoriasis?
It could be Polytar, Exorex, Sebco, or Psoriderm
Do you have a history of using oils or other creams to treat psoriasis?
If so, what did you use and how successful was it?
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.
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