A simple 5 step form

Receive your consultation in as little as 24 hours

What is the Patients Name?

Please enter the patients full name

Their Date of Birth *

Gender *

Is there any possibility you are or may become pregnant in the next 6 weeks?

Step 2 of 5

Tell me about the condition

How long have you had the condition? *

Your skin colour?

Your hair colour?

Your eye colour?

Please upload pictures of the issue (Good Focus & Good Light)

Drag files here or browse

Step 3 of 5

GP Details

We need to inform your GP for their records if medication is prescribed.

Would you like us to share this information with your GP?

GP name *

GP address *

GP telephone or email

Step 4 of 5

A Couple of Medical Questions

Please select which is most relevant

Are you diabetic?

Diabetic Details

Do you have any allergies?

Allergie Details

Are you taking any prescription medication?

Prescription Details

Are you taking any non prescription medication, herbal medicines or illegal drugs?

Medication Deails

Are you being treated for any other medical condition?

Have you been diagnosed for this condition before?

Yes

No

Since you answered yes. What was the diagnosis given ?

When were you last in a sunny climate and for how long ?

Do you burn easily ?

Yes

No

Do you use sunbeds Or have you in the recent past ?

Yes

No

Other Medical Condition Details

Final step, the Dr will consult in as little as 24 hours.

A Couple of Medical Questions

Please select which is most relevant

Is it a Rash?

a Lesion (lump/mole)?

or other?

Where did the issue originate ?

If the issue covers a wider area please tell us where on your body it very first started.

Please give us as much information on the issue as possible. *

i.e - History, Treatments, Past Diagnosis, Possible Causes, Family History

What would you say your current stress level is ?

Low

Medium

High

Online Consultation

A simple 5 step form

Receive your consultation in as little as 24 hours

Step 2 of 5

Tell me about the condition

Step 3 of 5

GP Details

Step 4 of 5

A Couple of Medical Questions

Final step, the Dr will consult in as little as 24 hours.

A Couple of Medical Questions

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Online Consultation-

Online Consultation