Skin Care For Common Conditions At YourPharmacy

Differin Cream

Strength – 0.1% Adapalene

Available in 45g or 60g

£24.95 - £28.99

Differin Cream Consultation

"*" indicates required fields

Step 1 of 9

11%

Prescription Only Medication Consultation

As this is a Prescription medication it is required by law, that you have a short consultation beforehand to make sure this treatment is suitable for you. It shouldn’t take any longer than 4 minutes.

As Differin Cream is a prescription-only medication, this short consultation form is essential to make sure treatment method is safe for you.

Terms and Conditions*

I confirm and understand all of the above

Personal Information

Name*

First Last

Email Address*

Date of birth*

Day

Month

Year

Gender*

Address*

Street Address Address Line 2 City Post Code Country

Medical History

Do you have any known allergies to medications or skincare ingredients?*

Yes

If Yes (Please specify)*

Are you currently taking any prescription or over-the-counter medications, including herbal supplements?*

Yes

If Yes (Please specify)

Do you have or have you ever had any of the following? (Check all that apply)*

Eczema

Rosacea

Psoriasis

Acne

Other

How would you describe the severity of your Acne?*

Mild

Moderate

Severe

If other (Please specify)*

Are you currently pregnant, planning to become pregnant, or breastfeeding?*

Yes

Skin Condition & Treatment History

Have you previously used any acne medication including Differin, Epiduo, or Skinoren?*

Yes

Other

If Yes or Other, please let us know which product and for how long.*

Please Upload a picture of your face*

Drop files here or

Accepted file types: jpg, png, Max. file size: 2 GB.

This is so the pharmacist can assess whether the treatment is suitable for you.

Have you experienced any adverse reactions to topical acne treatments in the past?*

Yes

If Yes, Please specify

What skincare products are you currently using? (Cleanser, moisturiser, sunscreen, etc.)*

Lifestyle & Skin Sensitivity

Do you have sensitive skin or experience frequent irritation with skincare products?*

Yes

How often do you expose your skin to direct sunlight or tanning beds?*

Rarely

Occasionally

Frequently

Do you consistently use sunscreen (SPF 30+)?*

Yes

Suitability & Precautions

Have you ever used products containing benzoyl peroxide, adapalene, or azelaic acid before?

Yes

If yes please specify*

Are you aware that these treatments may cause initial irritation, redness, or dryness?*

Yes

Do you understand the importance of applying a small amount and gradually increasing use?*

Yes

Do you consent for YourPharmacy to check NSCR to confirm your identity and your suitability for this treatment?*

Yes

We recommend that you notify your GP about any treatments you take, Would you like us to share your consultation to your GP and your treatment plan?*

Yes

Name of GP*

Patient Acknowledgement & Consent

What is your preferred method of contact?*

Phone

Consent & Agreement*

I confirm that the above information is accurate to the best of my knowledge. I understand the potential side effects and proper usage of Differin, Epiduo, or Skinoren. I acknowledge that misuse or overuse may lead to skin irritation.

All information I have provided is accurate and honest to enable YourPharmacy prescribers to make the best decision in regards to my health.

I will read, understand and follow the instructions in the patient information leaflet, including the risks and side effects, before taking my treatment.

I am happy for the YourPharmacy clinicians to contact me if necessary to ensure suitability and safety.

I am aware YourPharmacy can refuse or withdraw service without providing a reason (a refund will be issued) .

I will seek medical advice via a GP, NHS 111, walk in centre, pharmacy and if necessary, A&E if I experience any adverse effects from my treatment.

I will seek medical advice if my medical circumstances or condition changes.

I consent to be contacted via AccuRx, Email or by Phone.

I agree to the terms and conditions

Differin Gel

Strength – 0.1% Adapalene

Available in 45g or 60g

£24.95 - £28.99

Differin Gel Consultation

"*" indicates required fields

Step 1 of 9

11%

Prescription Only Medication Consultation

As Differin Gel is a prescription-only medication, this short consultation form is essential to make sure treatment method is safe for you.

Terms and Conditions*

I confirm and understand all of the above

Personal Information

Name*

First Last

Email Address*

Date of birth*

Day

Month

Year

Gender*

Address*

Street Address Address Line 2 City Post Code Country

Medical History

Do you have any known allergies to medications or skincare ingredients?*

Yes

If Yes (Please specify)*

Are you currently taking any prescription or over-the-counter medications, including herbal supplements?*

Yes

If Yes (Please specify)

Do you have or have you ever had any of the following? (Check all that apply)*

Eczema

Rosacea

Psoriasis

Acne

Other

How would you describe the severity of your Acne?*

Mild

Moderate

Severe

If other (Please specify)*

Are you currently pregnant, planning to become pregnant, or breastfeeding?*

Yes

Skin Condition & Treatment History

Have you previously used any acne medication including Differin, Epiduo, or Skinoren?*

Yes

Other

If Yes or Other, please let us know which product and for how long.*

Please Upload a picture of your face*

Drop files here or

Accepted file types: jpg, png, Max. file size: 2 GB.

This is so the pharmacist can assess whether the treatment is suitable for you.

Have you experienced any adverse reactions to topical acne treatments in the past?*

Yes

If Yes, Please specify

What skincare products are you currently using? (Cleanser, moisturiser, sunscreen, etc.)*

Lifestyle & Skin Sensitivity

Do you have sensitive skin or experience frequent irritation with skincare products?*

Yes

How often do you expose your skin to direct sunlight or tanning beds?*

Rarely

Occasionally

Frequently

Do you consistently use sunscreen (SPF 30+)?*

Yes

Suitability & Precautions

Have you ever used products containing benzoyl peroxide, adapalene, or azelaic acid before?

Yes

If yes please specify*

Are you aware that these treatments may cause initial irritation, redness, or dryness?*

Yes

Do you understand the importance of applying a small amount and gradually increasing use?*

Yes

We recommend that you notify your GP about any treatments you take, Would you like us to share your consultation to your GP and your treatment plan?

Yes

Name of GP*

Do you consent for YourPharmacy to check NSCR to confirm your identity and your suitability for this treatment?*

Yes

Patient Acknowledgement & Consent

What is your preferred method of contact?*

Phone

Consent & Agreement*

All information I have provided is accurate and honest to enable YourPharmacy prescribers to make the best decision in regards to my health.

I will read, understand and follow the instructions in the patient information leaflet, including the risks and side effects, before taking my treatment.

I am happy for the YourPharmacy clinicians to contact me if necessary to ensure suitability and safety.

I am aware YourPharmacy can refuse or withdraw service without providing a reason (a refund will be issued) .

I will seek medical advice via a GP, NHS 111, walk in centre, pharmacy and if necessary, A&E if I experience any adverse effects from my treatment.

I will seek medical advice if my medical circumstances or condition changes.

I consent to be contacted via AccuRx, Email or by Phone.

I agree to the terms and conditions

Epiduo Gel

Strength – 0.1% Adapalene / 2.5% Benzoyl Peroxide

Available in 45g or 60g

£34.95

Epiduo 0.1% Gel Consultation

"*" indicates required fields

Step 1 of 8

12%

As Epiduo Gel is a prescription-only medication, this short consultation form is essential to make sure treatment method is safe for you.

Terms and Conditions*

I confirm and understand all of the above

Personal Information

Name*

First Last

Email Address*

Date of birth*

Day

Month

Year

Gender*

Address*

Street Address Address Line 2 City Post Code Country

Medical History

Do you have any known allergies to medications or skincare ingredients?*

Yes

If Yes (Please specify)*

Are you currently taking any prescription or over-the-counter medications, including herbal supplements?*

Yes

If Yes (Please specify)

Do you have or have you ever had any of the following? (Check all that apply)*

Eczema

Rosacea

Psoriasis

Acne

Other

How would you describe the severity of your Acne?*

Mild

Moderate

Severe

If other (Please specify)*

Are you currently pregnant, planning to become pregnant, or breastfeeding?*

Yes

Skin Condition & Treatment History

Have you previously used any acne medication including Differin, Epiduo, or Skinoren?*

Yes

Other

If Yes or Other, please let us know which product and for how long.*

Please Upload a picture of your face*

Drop files here or

Accepted file types: jpg, png, Max. file size: 2 GB.

This is so the pharmacist can assess whether the treatment is suitable for you.

Have you experienced any adverse reactions to topical acne treatments in the past?*

Yes

If Yes, Please specify

What skincare products are you currently using? (Cleanser, moisturiser, sunscreen, etc.)*

Lifestyle & Skin Sensitivity

Do you have sensitive skin or experience frequent irritation with skincare products?*

Yes

How often do you expose your skin to direct sunlight or tanning beds?*

Rarely

Occasionally

Frequently

Do you consistently use sunscreen (SPF 30+)?*

Yes

Suitability & Precautions

Have you ever used products containing benzoyl peroxide, adapalene, or azelaic acid before?

Yes

If yes please specify*

Are you aware that these treatments may cause initial irritation, redness, or dryness?*

Yes

Do you understand the importance of applying a small amount and gradually increasing use?*

Yes

Do you consent for YourPharmacy to check NSCR to confirm your identity and your suitability for this treatment?*

Yes

We recommend that you notify your GP about any treatments you take, Would you like us to share your consultation to your GP and your treatment plan?

Yes

Name of GP*

Patient Acknowledgement & Consent

What is your preferred method of contact?*

Phone

Consent & Agreement*

All information I have provided is accurate and honest to enable YourPharmacy prescribers to make the best decision in regards to my health.

I will read, understand and follow the instructions in the patient information leaflet, including the risks and side effects, before taking my treatment.

I am happy for the YourPharmacy clinicians to contact me if necessary to ensure suitability and safety.

I am aware YourPharmacy can refuse or withdraw service without providing a reason (a refund will be issued) .

I will seek medical advice via a GP, NHS 111, walk in centre, pharmacy and if necessary, A&E if I experience any adverse effects from my treatment.

I will seek medical advice if my medical circumstances or condition changes.

I consent to be contacted via AccuRx, Email or by Phone.

I agree to the terms and conditions

Epiduo Gel

Strength – 0.3% Adapalene / 2.5% Benzoyl Peroxide

Available in 45g or 60g

£36.95

Epiduo 0.3% Gel Consultation

"*" indicates required fields

Step 1 of 8

12%

As Epiduo Gel is a prescription-only medication, this short consultation form is essential to make sure treatment method is safe for you.

Terms and Conditions*

I confirm and understand all of the above

Personal Information

Name*

First Last

Email Address*

Date of birth*

Day

Month

Year

Gender*

Address*

Street Address Address Line 2 City Post Code Country

Medical History

Do you have any known allergies to medications or skincare ingredients?*

Yes

If Yes (Please specify)*

Are you currently taking any prescription or over-the-counter medications, including herbal supplements?*

Yes

If Yes (Please specify)

Do you have or have you ever had any of the following? (Check all that apply)*

Eczema

Rosacea

Psoriasis

Acne

Other

How would you describe the severity of your Acne?*

Mild

Moderate

Severe

If other (Please specify)*

Are you currently pregnant, planning to become pregnant, or breastfeeding?*

Yes

Skin Condition & Treatment History

Have you previously used any acne medication including Differin, Epiduo, or Skinoren?*

Yes

Other

If Yes or Other, please let us know which product and for how long.*

Please Upload a picture of your face*

Drop files here or

Accepted file types: jpg, png, Max. file size: 2 GB.

This is so the pharmacist can assess whether the treatment is suitable for you.

Have you experienced any adverse reactions to topical acne treatments in the past?*

Yes

If Yes, Please specify

What skincare products are you currently using? (Cleanser, moisturiser, sunscreen, etc.)*

Lifestyle & Skin Sensitivity

Do you have sensitive skin or experience frequent irritation with skincare products?*

Yes

How often do you expose your skin to direct sunlight or tanning beds?*

Rarely

Occasionally

Frequently

Do you consistently use sunscreen (SPF 30+)?*

Yes

Suitability & Precautions

Have you ever used products containing benzoyl peroxide, adapalene, or azelaic acid before?

Yes

If yes please specify*

Are you aware that these treatments may cause initial irritation, redness, or dryness?*

Yes

Do you understand the importance of applying a small amount and gradually increasing use?*

Yes

Do you consent for YourPharmacy to check NSCR to confirm your identity and your suitability for this treatment?*

Yes

We recommend that you notify your GP about any treatments you take, Would you like us to share your consultation to your GP and your treatment plan?*

Yes

Name of GP*

Patient Acknowledgement & Consent

What is your preferred method of contact?*

Phone

Consent & Agreement*

All information I have provided is accurate and honest to enable YourPharmacy prescribers to make the best decision in regards to my health.

I will read, understand and follow the instructions in the patient information leaflet, including the risks and side effects, before taking my treatment.

I am happy for the YourPharmacy clinicians to contact me if necessary to ensure suitability and safety.

I am aware YourPharmacy can refuse or withdraw service without providing a reason (a refund will be issued) .

I will seek medical advice via a GP, NHS 111, walk in centre, pharmacy and if necessary, A&E if I experience any adverse effects from my treatment.

I will seek medical advice if my medical circumstances or condition changes.

I consent to be contacted via AccuRx, Email or by Phone.

I agree to the terms and conditions

Skinoren Cream

Strength – 20% Azelaic Acid

Available in 30g

£14.99

Skinoren Consultation

"*" indicates required fields

Step 1 of 9

11%

Prescription Only Medication Consultation

As Skinoren is a prescription-only medication, this short consultation form is essential to make sure treatment method is safe for you.

Terms and Conditions*

I confirm and understand all of the above

Personal Information

Name*

First Last

Email Address*

Date of birth*

Day

Month

Year

Gender*

Address*

Street Address Address Line 2 City ZIP / Postal Code Country

Medical History

Do you have any known allergies to medications or skincare ingredients?*

Yes

If Yes (Please specify)*

Are you currently taking any prescription or over-the-counter medications, including herbal supplements?*

Yes

If Yes (Please specify)

Do you have or have you ever had any of the following? (Check all that apply)*

Eczema

Rosacea

Psoriasis

Acne

Other

How would you describe the severity of your Acne?*

Mild

Moderate

Severe

If other (Please specify)*

Are you currently pregnant, planning to become pregnant, or breastfeeding?*

Yes

Skin Condition & Treatment History

Have you previously used any acne medication including Differin, Epiduo, or Skinoren?*

Yes

Other

If Yes or Other, please let us know which product and for how long.*

Please Upload a picture of your face*

Drop files here or

Accepted file types: jpg, png, Max. file size: 2 GB.

This is so the pharmacist can assess whether the treatment is suitable for you, once completed any images will be deleted.

Have you experienced any adverse reactions to topical acne treatments in the past?*

Yes

If Yes, Please specify

What skincare products are you currently using? (Cleanser, moisturiser, sunscreen, etc.)*

Lifestyle & Skin Sensitivity

Do you have sensitive skin or experience frequent irritation with skincare products?*

Yes

How often do you expose your skin to direct sunlight or tanning beds?*

Rarely

Occasionally

Frequently

Do you consistently use sunscreen (SPF 30+)?*

Yes

Suitability & Precautions

Have you ever used products containing benzoyl peroxide, adapalene, or azelaic acid before?

Yes

If yes please specify*

Are you aware that these treatments may cause initial irritation, redness, or dryness?*

Yes

Do you understand the importance of applying a small amount and gradually increasing use?*

Yes

We recommend that you notify your GP about any treatments you take, Would you like us to share your consultation to your GP and your treatment plan?

Yes

Name of GP*

Patient Acknowledgement & Consent

What is your preferred method of contact?*

Phone

AccuRx (Secure SMS)

SMS (+447787137117)

Consent & Agreement*

All information I have provided is accurate and honest to enable YourPharmacy prescribers to make the best decision in regards to my health.

I will read, understand and follow the instructions in the patient information leaflet, including the risks and side effects, before taking my treatment.

I am happy for the YourPharmacy clinicians to contact me if necessary to ensure suitability and safety.

I am aware YourPharmacy can refuse or withdraw service without providing a reason (a refund will be issued) .

I will seek medical advice via a GP, NHS 111, walk in centre, pharmacy and if necessary, A&E if I experience any adverse effects from my treatment.

I will seek medical advice if my medical circumstances or condition changes.

I consent to be contacted via AccuRx, Email or by Phone.

I agree to the terms and conditions

Actinic Keratosis

Creams for Actinic Keratosis

Efudix

Strength – 5% Fluorouracil

Available in 40g

Efudix Cream 5% tube – topical treatment for actinic keratosis and superficial skin cancers

£94.99

Efudix – Actinic Keratosis

Please answer the following questions as honestly as possible so we can ensure your preferred treatment is the best treatment for your needs.
Estimated time to complete: 4 minutes

"*" indicates required fields

Step 1 of 11

Efudix Cream Consultation for Actinic Keratosis

As this is a Prescription Only Medication, this is so that our team of Prescribers can safely review your consultation and make sure it is suitable for your needs.

Terms and Conditions*

I confirm and understand all of the above

Personal Information

Name*

First Last

Email Address*

Date of birth*

Day

Month

Year

Gender*

Address*

Street Address Address Line 2 City Post Code Country

Have you been diagnosed with actinic keratosis by a healthcare professional?*

Yes

Do you already have a valid private prescription?*

Please ensure the prescription has not been used before if you intend to use it here

Yes

Would like to use your existing private prescription?*

Please ensure the prescription has not been used before if you intend to use it here

Yes

Please upload a picture or PDF of your private prescription.*

Max. file size: 2 GB.

Medical History

Where on your body are the affected areas located?*

Face

Scalp

Ears

Hands

Forearms

Other

Please select all that apply.

Please give us more details*

How long have you had these lesions?*

Less than 3 months

3-12 Months

More than 12 Months

Have any lesions changed in size, shape, or started to bleed or ulcerate?*

Yes

Please give us more details*

Please upload some pictures of the affected area(s).*

Drop files here or

Max. file size: 2 GB, Max. files: 5.

Have you previously used Efudix or any other treatment for actinic keratosis?*

Yes

Please specify treatment and the response.*

General Health & Medication

Do you have any known allergies or sensitivities?*

Yes

If Yes (Please specify)

Are you currently using any other prescription or over-the-counter skin treatments?*

Yes

If Yes (Please Specify)

Are you taking any medications that suppress the immune system (e.g., steroids, chemotherapy, immunosuppressants)?*

Yes

If Yes (Please Specify)*

Do you have any history of skin cancer or a weakened immune system?*

Yes

If Yes, Please specify

Are you pregnant, breastfeeding, or planning to become pregnant?*

Yes

Efudix Treatment Suitability

Are you aware that Efudix causes redness, peeling, and crusting in the treated areas as part of the healing process?*

Yes

Do you understand that treated areas may become sore and inflamed before healing and that this is a normal reaction?*

Yes

Can you commit to avoiding sun exposure and using a high-factor sunscreen (SPF 50+) while using Efudix?*

Yes

Do you understand that treatment typically lasts 2-4 weeks, and you should stop earlier if severe ulceration or extreme irritation occurs?*

Yes

Do you want YourPharmacy to share this consultation and treatment plan with your GP*

We highly recommend this to ensure your safety throughout your treatment.

Yes

Name of GP*

Do you consent for YourPharmacy to check NSCR to confirm your identity and your suitability for this treatment?*

Yes

Consent & Agreement*

All information I have provided is accurate and honest to enable YourPharmacy prescribers to make the best decision in regards to my health.

I will read, understand and follow the instructions in the patient information leaflet, including the risks and side effects, before taking my treatment.

I am happy for the YourPharmacy clinicians to contact me if necessary to ensure suitability and safety.

I am aware YourPharmacy can refuse or withdraw service without providing a reason (a refund will be issued) .

I will seek medical advice via a GP, NHS 111, walk in centre, pharmacy and if necessary, A&E if I experience any adverse effects from my treatment.

I will seek medical advice if my medical circumstances or condition changes.

I consent to be contacted via AccuRx, Email or by Phone.

I agree to the terms and conditions

Have you already placed an order?*

Yes

Solaraze

Strength – 3% Diclofenac Sodium

Available in 50g

£69.99

Solaraze Gel – Actinic Keratosis

Please answer the following questions as honestly as possible so we can ensure your preferred treatment is the best treatment for your needs.
Estimated time to complete: 4 minutes

"*" indicates required fields

Step 1 of 9

11%

Solaraze Gel Consultation for Actinic Keratosis

As this is a Prescription Only Medication, this is so that our team of Prescribers can safely review your consultation and make sure it is suitable for your needs.

Terms and Conditions*

I confirm and understand all of the above

Personal Information

Name*

First Last

Email Address*

Date of birth*

Day

Month

Year

Gender*

Address*

Street Address Address Line 2 City Post Code Country

Medical History

Have you been diagnosed with actinic keratosis by a healthcare professional?*

Yes

Where on your body are the affected areas located?*

Face

Scalp

Ears

Hands

Forearms

Other

Please select all that apply.

Please give us more details*

How long have you had these lesions?*

Less than 3 months

3-12 Months

More than 12 Months

Have any lesions changed in size, shape, or started to bleed or ulcerate?*

Yes

Please give us more details*

Please upload some pictures of the affected area(s).*

Drop files here or

Max. file size: 2 GB.

Have you previously used Solaraze or any other treatment for actinic keratosis?*

Yes

Please specify treatment and the response.*

General Health & Medication

Do you have any known allergies or sensitivities?*

Yes

If Yes (Please specify)

Are you currently using any other prescription or over-the-counter skin treatments?*

Yes

If Yes (Please Specify)

Are you taking any medications that suppress the immune system (e.g., steroids, chemotherapy, immunosuppressants)?*

Yes

If Yes (Please Specify)*

Do you have any history of skin cancer or a weakened immune system?*

Yes

If Yes, Please specify

Are you pregnant, breastfeeding, or planning to become pregnant?*

Yes

Solareze Gel Treatment Suitability

Are you aware that Solaraze is a non-steroidal anti-inflammatory gel that works over 60-90 days and may cause mild skin irritation?*

Yes

Do you understand that treated areas may become red, dry, or slightly inflamed before healing and that this is a normal reaction?*

Yes

Can you commit to avoiding excessive sun exposure and using a high-factor sunscreen (SPF 50+) while using Solaraze?*

Yes

Do you understand that treatment typically lasts 60-90 days, and you should stop earlier if severe irritation or an allergic reaction occurs?*

Yes

Do you want YourPharmacy to share this consultation and treatment plan with your GP*

We highly recommend this to ensure your safety throughout your treatment.

Yes

Name of GP*

Do you consent for YourPharmacy to check NSCR to confirm your identity and your suitability for this treatment?*

Yes

Consent & Agreement*

All information I have provided is accurate and honest to enable YourPharmacy prescribers to make the best decision in regards to my health.

I will read, understand and follow the instructions in the patient information leaflet, including the risks and side effects, before taking my treatment.

I am happy for the YourPharmacy clinicians to contact me if necessary to ensure suitability and safety.

I am aware YourPharmacy can refuse or withdraw service without providing a reason (a refund will be issued) .

I will seek medical advice via a GP, NHS 111, walk in centre, pharmacy and if necessary, A&E if I experience any adverse effects from my treatment.

I will seek medical advice if my medical circumstances or condition changes.

I consent to be contacted via AccuRx, Email or by Phone.

I agree to the terms and conditions

Have you already placed an order?*

This is applicable to anyone we contact after you place an order and we need more information

Yes

Dandruff Relief/ Scalp Eczema

Shampoos and Lotions that help reduce the symptoms of Dandruff and Scalp Eczema

Nizoral

Strength – 2% Ketoconazole Shampoo

Available in 60ml

£12.99 - 19.99

E45 Dry Scalp Shampoo

Available in 200ml

£9.99

Elocon Scalp Lotion

Strength – 0.1% Mometasone Furoate

Available in 30ml

£12.99

Elocon Scalp Lotion Consultation

Please answer the following questions as honestly as possible so we can ensure your preferred treatment is the best treatment for your needs.
Estimated time to complete: 2 minutes

"*" indicates required fields

Step 1 of 7

14%

As Elocon Scalp Lotion is a prescription-only medication, this short consultation form is essential to make sure treatment method is safe for you.

Terms and Conditions*

I confirm and understand all of the above

Personal Information

Name*

First Last

Email Address*

Date of birth*

Day

Month

Year

Gender*

Medical History

Have you been diagnosed with dry skin, dermatitis, or another scalp condition by your GP or dermatologist?*

Yes

If Yes (Please give us more information)

Are you currently experiencing a flare up in your scalp condition?*

Yes

If Yes (Please specify)

Is this episode different in any way to when it was first diagnosed?*

Yes

If Yes (Please specify)

Are you currently taking any prescription or over-the-counter medications, including herbal supplements?*

Yes

If Yes (Please specify)

Elocon Scalp Lotion Consultation

How long have you had Scalp Eczema?*

Less than 3 months

3-6 months

More than 6 months

How severe is your scalp eczema?*

Mild

Moderate

Severe

Please Upload a picture of your scalp if possible*

Drop files here or

Max. file size: 2 GB.

This is so the pharmacist can assess whether the treatment is suitable for you.

Previous Treatment

Have you previously used any lotion/shampoos used to treat Scalp Eczema?*

Yes

If Yes, Please specify

Did you experience any side effects from previous treatments?*

Yes

if Yes (Please describe)

Do you use any creams/emollients?*

Yes

If Yes (How often?)

Do you consent for YourPharmacy to check NSCR to confirm your identity and your suitability for this treatment?*

Yes

Consent & Agreement*

All information I have provided is accurate and honest to enable YourPharmacy prescribers to make the best decision in regards to my health.

I will read, understand and follow the instructions in the patient information leaflet, including the risks and side effects, before taking my treatment.

I am happy for the YourPharmacy clinicians to contact me if necessary to ensure suitability and safety.

I am aware YourPharmacy can refuse or withdraw service without providing a reason (a refund will be issued) .

I will seek medical advice via a GP, NHS 111, walk in centre, pharmacy and if necessary, A&E if I experience any adverse effects from my treatment.

I will seek medical advice if my medical circumstances or condition changes.

I consent to be contacted via AccuRx, Email or by Phone.

I agree to the terms and conditions

Betacap Scalp Lotion

Strength – 0.1% Betamethasone

Available in 100ml

£14.99

Betacap Scalp Lotion Consultation

Please answer the following questions as honestly as possible so we can ensure your preferred treatment is the best treatment for your needs.
Estimated time to complete: 2 minutes

"*" indicates required fields

Step 1 of 7

14%

As Betacap Scalp Lotion is a prescription-only medication, this short consultation form is essential to make sure treatment method is safe for you.

Terms and Conditions*

I confirm and understand all of the above

Personal Information

Name*

First Last

Email Address*

Date of birth*

Day

Month

Year

Gender*

Medical History

Have you been diagnosed with dry skin, dermatitis, or another scalp condition by your GP or dermatologist?*

Yes

If Yes (Please give us more information)

Are you currently experiencing a flare up in your scalp condition?*

Yes

If Yes (Please specify)

Is this episode different in any way to when it was first diagnosed?*

Yes

If Yes (Please specify)

Are you currently taking any prescription or over-the-counter medications, including herbal supplements?*

Yes

If Yes (Please specify)

Betacap Scalp Lotion Consultation

How long have you had Scalp Eczema?*

Less than 3 months

3-6 months

More than 6 months

How severe is your scalp eczema?*

Mild

Moderate

Severe

Please Upload a picture of your scalp if possible*

Drop files here or

Max. file size: 2 GB.

This is so the pharmacist can assess whether the treatment is suitable for you.

Previous Treatment

Have you previously used any lotion/shampoos used to treat Scalp Eczema?*

Yes

If Yes, Please specify

Did you experience any side effects from previous treatments?*

Yes

if Yes (Please describe)

Do you use any creams/emollients?*

Yes

If Yes (How often?)

Do you want us to send your GP a copy of your treatment plan?*

Yes

Name of GP*

Do you consent for YourPharmacy to check NSCR to confirm your identity and your suitability for this treatment?*

Yes

Have you already placed an order?*

Yes

If you have been asked by us to complete this form after you purchased something please press “Yes”

Consent & Agreement*

All information I have provided is accurate and honest to enable YourPharmacy prescribers to make the best decision in regards to my health.

I will read, understand and follow the instructions in the patient information leaflet, including the risks and side effects, before taking my treatment.

I am happy for the YourPharmacy clinicians to contact me if necessary to ensure suitability and safety.

I am aware YourPharmacy can refuse or withdraw service without providing a reason (a refund will be issued) .

I will seek medical advice via a GP, NHS 111, walk in centre, pharmacy and if necessary, A&E if I experience any adverse effects from my treatment.

I will seek medical advice if my medical circumstances or condition changes.

I consent to be contacted via Phone, Email or by WhatsApp.

I agree to the terms and conditions

Dry Skin

Creams or Ointments that can help reduce symptoms of Dry Skin

Aveeno Daily Moisturising Lotion

Available in 300ml or 500ml

£8.29 - £11.99

Aveeno Daily Moisturising Creamy Oil

Available in 300ml

£9.99

Oilatum Cream

Available in 500ml

£15.99

Oilatum Junior Cream

Available in 500ml

£15.99

Eucerin Urea Repair Original

Strength – 10% Urea Cream

Available in 100ml

£16.99

Flexitol Rescue Heel Balm

Strength – 25% Urea

Available in 56g or 112g

£7.99 - £13.49

On this Page
> Acne
> Actinic Keratosis
> Dandruff / Scalp Eczema
> Dry Skin
> Eczema
> Scabies and Crab Lice

Eczema

Creams or Ointments that can help reduce symptoms of Eczema

Epimax

Available in 100g and 500g

Available in Original, Oatmeal, Isomol, Excetra and Moisturising.

£4 - £16.99

Hydromol Cream

Available in 500g

£20

Zerobase

Sizes Available:

50g or 500g

£4.69 - £12.99

Zerocream

Sizes Available:

50g or 500g

£4.69 - £12.99

Zeroveen

Sizes Available:

100g or 500g

£5.49 - £14.99

Balneum Plus Cream

Sizes Available:

100g or 500g

£5.99 - 21.99

Scabies Treatments

Creams for treat scabies

Permethrin

Strength – 5% Permethrin

Available in 30g

£11

Permethrin Consultation

Please answer the following questions as honestly as possible so we can ensure your preferred treatment is the best treatment for your needs.
Estimated time to complete: 3 minutes

"*" indicates required fields

Step 1 of 9

11%

Pharmacy Only Medication Consultation

As this is a Pharmacy Only product it is required by law, that you have a short consultation beforehand to make sure this treatment is suitable for you. It shouldn’t take any longer than 2 minutes.

As Permethrin is a Pharmacy-only medication, you must fill out a very short consultation.

Terms and Conditions*

I confirm and understand all of the above

Personal Information

Name*

First Last

Email Address*

Phone Number*

Date of birth*

Day

Month

Year

Gender*

About You

What condition is the cream being used to treat?*

Scabies

Other (Please specify)

Please specify*

When did the symptoms first appear?*

Contact History

Have any household members or close contacts shown symptoms?*

Yes

Will all household/close contacts be treated at the same time*

If this is the case they must complete their own forms after.

Yes

If other, please specify*

Have you used permethrin cream before?*

Yes

If yes, did you experience any side effects, please explain.*

Have you used any other treatments for this condition?*

Yes

If yes, which product and when?*

Do you the person being treated have:*

Allergies to Permethrin, Chrysanthemums, or Pyrethroids?

Skin conditions (e.g. Eczema, Psoriasis, Broken skin)

Asthma or breathing issues?

Please specify more information*

Are you currently taking any prescribed or over the counter medications including herbal remedies?*

Yes

If yes please specify*

Are you currently pregnant, planning to become pregnant, or breastfeeding?*

Pregnant

Planning to become pregnant

Breastfeeding

None of the above

Please upload a picture of the affected area.*

Please note once our pharmacists have reviewed your consultation the image will be deleted

Drop files here or

Max. file size: 2 GB, Max. files: 3.

Important Information*

Please note that it is important to ensure all contacts are treated if they are showing symptoms

It is important to wash all clothes, bedding and towels regularly

Itching may persist after treatment

That you may need to re-treat (usually after 7 days)

You understand that you must seek medical attention immediately if you experience a reaction, or get an infection

I understand

Do you have any additonal comments?

Consent & Agreement*

All information I have provided is accurate and honest to enable YourPharmacy prescribers to make the best decision in regards to my health.

I will read, understand and follow the instructions in the patient information leaflet, including the risks and side effects, before taking my treatment.

I am happy for the YourPharmacy clinicians to contact me if necessary to ensure suitability and safety.

I am aware YourPharmacy can refuse or withdraw service without providing a reason (a refund will be issued) .

I will seek medical advice via a GP, NHS 111, walk in centre, pharmacy and if necessary, A&E if I experience any adverse effects from my treatment.

I will seek medical advice if my medical circumstances or condition changes.

I consent to be contacted via AccuRx, Email or by Phone.

I agree to the terms and conditions

Have you already placed a recent order with us?

Yes

Lyclear Dermal Cream

Strength – 5% Permethrin

Available in 30g

£16.99

Lyclear Dermal Cream Consultation

Please answer the following questions as honestly as possible so we can ensure your preferred treatment is the best treatment for your needs.
Estimated time to complete: 3 minutes

"*" indicates required fields

Step 1 of 9

11%

Pharmacy Only Medication Consultation

As this is a Pharmacy Only product it is required by law, that you have a short consultation beforehand to make sure this treatment is suitable for you. It shouldn’t take any longer than 2 minutes.

As Lyclear is a Pharmacy-only medication, you must fill out a very short consultation.

Terms and Conditions*

I confirm and understand all of the above

Personal Information

Name*

First Last

Email Address*

Phone Number*

Date of birth*

Day

Month

Year

Gender*

About You

What condition is the cream being used to treat?*

Scabies

Other (Please specify)

Please specify*

When did the symptoms first appear?*

Contact History

Have any household members or close contacts shown symptoms?*

Yes

Will all household/close contacts be treated at the same time*

If this is the case they must complete their own forms after.

Yes

If other, please specify*

Have you used permethrin cream before?*

Yes

If yes, did you experience any side effects, please explain.*

Have you used any other treatments for this condition?*

Yes

If yes, which product and when?*

Do you the person being treated have:*

Allergies to Permethrin, Chrysanthemums, or Pyrethroids?

Skin conditions (e.g. Eczema, Psoriasis, Broken skin)

Asthma or breathing issues?

Please specify more information*

Are you currently taking any prescribed or over the counter medications including herbal remedies?*

Yes

If yes please specify*

Are you currently pregnant, planning to become pregnant, or breastfeeding?*

Pregnant

Planning to become pregnant

Breastfeeding

None of the above

Please upload a picture of the affected area.*

Please note once our pharmacists have reviewed your consultation the image will be deleted

Drop files here or

Max. file size: 2 GB, Max. files: 3.

Important Information*

Please note that it is important to ensure all contacts are treated if they are showing symptoms

It is important to wash all clothes, bedding and towels regularly

Itching may persist after treatment

That you may need to re-treat (usually after 7 days)

You understand that you must seek medical attention immediately if you experience a reaction, or get an infection

I understand

Do you have any additonal comments?

Consent & Agreement*

All information I have provided is accurate and honest to enable YourPharmacy prescribers to make the best decision in regards to my health.

I will read, understand and follow the instructions in the patient information leaflet, including the risks and side effects, before taking my treatment.

I am happy for the YourPharmacy clinicians to contact me if necessary to ensure suitability and safety.

I am aware YourPharmacy can refuse or withdraw service without providing a reason (a refund will be issued) .

I will seek medical advice via a GP, NHS 111, walk in centre, pharmacy and if necessary, A&E if I experience any adverse effects from my treatment.

I will seek medical advice if my medical circumstances or condition changes.

I consent to be contacted via AccuRx, Email or by Phone.

I agree to the terms and conditions

Have you already placed a recent order with us?

Yes