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OnlineDoc Treatment
Hand Eczema Treatment
Only
€
23 per Script
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Hand Eczema Treatment
First Name
Last Name
Date Of Birth
Email
Phone Number
Address
Please specify your gender:
*
Male
Female
Please upload some photos of your current skin issue here.
Upload File
Upload supported file (Max 15MB)
How long do you have it?
Where did it start?
Has the leasion spread?
*
No
Yes
If Yes, Please specify:
Are there any obvious factors that either trigger or relieve the problem?
*
No
Yes
If Yes, Please specify:
Which one of the below signs do you have? Please select
*
Required
Dry skin
Itching, which may be severe, especially at night
Red to brownish-gray patches on the hands
Small, raised bumps, which may leak fluid and crust over when scratched
Thickened, cracked, scaly skin
Raw, sensitive, swollen skin from scratching
Non of them
Other (Please Specify)
If Others, Please specify:
Do you plan to become pregnant, breastfeed, or are you pregnant? (For Females)
*
No
Yes
If Yes, Please specify:
Do you have a significant past medical or surgical history?
*
No
Yes
If Yes, Please specify:
Are you allergic to any medication or any other substance?
*
No
Yes
If Yes, Please specify:
Please provide the name and address of the pharmacy where you'd like to pick up your medications.
I confirm that the answers I have provided for the above questions are true and accurate to the best of my knowledge.
*
I Confirm
I Do Not Confirm
I confirm and agree that any treatment prescribed for me is for my personal use only.
*
I Confirm
I Do Not Confirm
I fully understand the side-effects of the treatment options, their effectiveness and alternative options and am happy to continue with my request.
*
I Confirm
I Do Not Confirm
Proceed to Checkout
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