Rashes & Itching

Explain your symptoms or tell us how we can help today.*

Do you have allergies to any medications?*

Yes
No

If yes, please list any medications you have allergies to:

Are you pregnant or breastfeeding?*

Yes
No

Unfortunately we cannot proceed with your request based on the information you have provided.

What is your skin type?*

What symptoms have you been experiencing recently?*

Area of skin that feels tingly or itchy
Area of skin with burning sensation
Area of skin with numbness
Area of skin with sensitivity
Area of skin with redness
Lumps or bumps on the skin
Sores or infection in the skin
Other
I don’t have any of these symptoms

Unfortunately we cannot proceed with your request based on the information you have provided.

If you've listed "other", please explain your symptoms:*

How long have you been having these symptoms?*

Started today
1-3 days
4-7 days
Over 1 week

Have you ever been treated for rashes?*

Yes
No

How long ago?*

What medications were you treated with?*

Hydrocortisone (anti-itch) cream
Antihistamines
Antifungal medications
Steroids (prednisone)
Other

Please list the treatment plan:*

Did treatment work?*

Yes
No

Would you prefer the same treatment?*

Yes
No
Leave to doctor’s discretion

Smoker?*

Yes
No
Never

Alcohol use?*

Any medical family history?*

Yes
No

Please explain your medical family history:*

Do you have any medical conditions?*

Yes
No

Please explain your medical conditions:*

Have you ever had any surgeries or recent hospitalizations?*

Yes
No

Please explain your surgeries or recent hospitalizations:*

Do you currently take any medications, herbals, or supplements?*

Yes
No

Please list any medications, herbals, or supplements:*

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