Medical Assessment

Which skin condition are you suffering from?




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Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Please tell us what symptoms you are suffering from. Tick all the symptoms that apply to you:





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For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Have you been diagnosed with eczema and/or psoriasis by a doctor?

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Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Where is your psoriasis and/or eczema located? Tick all the areas affected:













Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you currently treating your eczema and/or psoriasis with any other products or medication (whether they're over the counter or prescription)?

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For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Does any of the following apply to you?

  • your eczema/psoriasis is getting a lot worse recently;
  • there is fluid oozing from the skin;
  • there is a yellow crust on the skin surface or small yellowish-white spots appearing in the eczema/psoriasis;
  • your skin is becoming swollen and sore;
  • you are feeling hot and shivery and generally unwell;
Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Does any of the following apply to you?

  • you are treated by systemic (oral) route for a calcium deficiency ;
  • you have any condition affecting your kidneys, urinary system or liver;
  • you have problems with your body’s immune system;
  • you have any other health condition that we should know about;
  • you have high blood calcium levels or if you suffer from abnormal calcium metabolism;
Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you allergic to nuts (especially coconut), calcitriol, betamethasone or mometasone?

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For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you taking any of the following?

  • Thiazide diuretics ;
  • Digoxin;
  • Calcium supplements or high doses of vitamin D;
Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you taking any other medication not mentioned above?

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For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you pregnant or breastfeeding or planning to get pregnant or start breastfeeding?

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For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you aware of the following?

  • you should see your doctor if your condition does not improve within 7 days.;
  • Betacap and Elocon should not be used continuously for prolonged periods (weeks or months) without the instruction from your doctor.;
  • Betacap and Elocon scalp lotion should not be applied under a bandage or to a broken skin;
  • Betacap and Elocon scalp lotion should not be applied near the eyes or eyelids;
  • Betacap Scalp Application is highly flammable and you should not use a hairdryer or smoke after using Betacap;
Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Do you agree to the following?

  • you answered truthfully to all the questions and you are aware that any incorrect information you provided might present a danger to your health;
  • you will seek medical attention if you experience any unusual side effects;
  • if your condition gets worse or does not improve while using this medication you will contact your doctor immediately ;
  • the treatment is solely for your own use ;
  • you will read the patient information leaflet supplied with your medication;
Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Please tick the boxes to confirm the following:

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