Have you been diagnosed with dry skin or eczema?

If you have a rash that is new or undiagnosed it is best to see a doctor.

Do you have any problems with your liver or kidneys?

Are you aware you need to see a doctor about new rashes, worsening rashes or rashes not responding to treatment?

Are you aware some emollients and emulsifiers are flammable and can make bathroom surface slippery?

Is your current flare up any different to past episodes of eczema or dermatitis?

Are you aware paraffin containing preparations can soak into clothing and bedding and cause a fire hazard?

Avoid smoking and naked flames.

Do you know that:

You should always keep affected skin moisturised with an emollient cream or ointment

Do you agree to the following? 

• You will read the Patient Information Leaflet supplied with your medication
• You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication, or if your medical conditions change during treatment
• The treatment is solely for your own use
• You are over the age of 18 and you have entered your own information for our identity verification checks
• You have answered all the above questions accurately and truthfully
• You understand our doctors take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
• You will inform your own GP of this purchase if appropriate
• You have read our privacy policy, cookie policy, patient agreement, data sharing agreement and Terms & Conditions

What is the name of your GP surgery and do you consent to us contacting them about your treatment?