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If you need any help with your consultation or have an enquiry, call us on
08000584381
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Online Consultation
£
75.00
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
*
Choose an option
Male
Female
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
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