Which skin condition are you suffering from?

eczema
psoriasis
both

We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

0207 867 3932

email help@clickpharmacy.co.uk.

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

patches of skin that are dry, red and covered in silver scales in some cases causing itching or soreness
pus-filled blisters (pustules) to appear on your skin
areas of skin that are itchy, dry, cracked and sore
Other - please specify

We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

0207 867 3932

email help@clickpharmacy.co.uk.

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

Yes No

Why do you think you suffer from eczema and/or psoriasis?

We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

0207 867 3932

email help@clickpharmacy.co.uk.

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

the insides of the elbows
backs of the knees
scalp
lower back
nails
chest
arms or legs
armpits
groin
hands (especially fingers)
face
Other - please specify

We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

0207 867 3932

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)?

Yes No

please provide the names of the products/medications you are currently using:

We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

0207 867 3932

email help@clickpharmacy.co.uk.

Does any of the following apply to you?

Yes No

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;

can you please provide more details?

We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

0207 867 3932

email help@clickpharmacy.co.uk.

Does any of the following apply to you?

Yes No

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;

can you please provide more details?

We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

0207 867 3932

email help@clickpharmacy.co.uk.

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

Yes No

can you please provide more details?

We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

0207 867 3932

email help@clickpharmacy.co.uk.

Are you taking any of the following?

Yes No

Thiazide diuretics ;
Digoxin;
Calcium supplements or high doses of vitamin D;

Please provide the name, dosage and the reason why you are taking that medication or medications

We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

0207 867 3932

email help@clickpharmacy.co.uk.

Are you taking any other medication not mentioned above?

Yes No

Please provide the name, dosage and the reason why you are taking that medication or medications

We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

0207 867 3932

email help@clickpharmacy.co.uk.

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

Yes No

We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

0207 867 3932

email help@clickpharmacy.co.uk.

Are you aware of the following?

Yes No

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;

We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

0207 867 3932

email help@clickpharmacy.co.uk.

Do you agree to the following?

Yes No

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;

We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

0207 867 3932

email help@clickpharmacy.co.uk.

Please tick the boxes to confirm the following:

I confirm that I am over 18 and I agree to the Terms and Conditions and the Privacy Policy.

You must accept the terms and conditions to continue!

Medical Assessment