Atopic Dermatitis – GoodpillRx

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Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Goodpillrx Pharmacy's Telehealth Dept Offers Prescriptions By U.S. Licensed Doctors

Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Goodpillrx Pharmacy's Telehealth Dept Offers Prescriptions By U.S. Licensed Doctors

Home
Shop
For Providers
About us
Contact us

Generic selectors

Exact matches only

Exact matches only

Search in title

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product

post

post

page

page

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product_variation

Filter by Categories

Uncategorized

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Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Goodpillrx Pharmacy's Telehealth Dept Offers Prescriptions By U.S. Licensed Doctors

Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Atopic Dermatitis

"*" indicates required fields

Name*

First Last

Email*

Phone*

Address*

Street Address City State ZIP Code

What is your date of birth?*

MM slash DD slash YYYY

What is your height?*

What is your weight?*

What is your gender?*

Male

Female

Are you currently breastfeeding, currently pregnant, or may become pregnant in the near future?*

Yes

No

Not sure

Please list all medications prescribed to you even if you don't take them every day. Include vitamins, and dietary supplements. Enter medicines including name, dose, frequency, and reason for taking.*

Please list your allergies, including any allergies to medications.*

Have you been diagnosed with eczema before?*

Yes

No

When were you diagnosed?*

Over the last 7 days or more, have you experienced any of the following?*

Dry skin

Itching skin

Sleep disturbance due to discomfort

Flaking skin

Oozing and/or crusting of the skin from open areas

Bleeding skin

Cracked skin

None apply.

Have you experienced any of the following since your symptoms began?*

Swelling of the specified area(s)

Tender red streaks of the skin that move away from the affected area

Color changes to the surrounding skin (pink, purple, brown, or grey)

Thick white patches of skin

None apply.

Please select which area(s) of the body are affected.*

Face (forehead, cheeks)

Near the eyes or on the eyelids

Arm(s)

Leg(s)

Stomach/chest

Back

Other

None

Have you previously been treated with oral or topical steroids for treatment of eczema?*

Yes

No

Please list the medication, the dose, and the duration of treatment.*

Are you currently using a topical steroid?*

Yes

No

what is the name, form (cream, ointment, lotion, etc.) and strength of the medication?*

How often do you experience flare-ups of your eczema?*

Have you been diagnosed with any of the following?*

Asthma

Allergic rhinitis (Seasonal allergies)

Allergy to NSAIDs (Ibuprofen, ketarolac, naproxen)/Aspirin

Skin cancer

None

What type of skin cancer? Where was it located? How was it treated? How long ago was it treated?*

How long have you had your current symptoms / changes to your skin?*

Have you tried any at home or over the counter remedies?*

Yes

No

list medications you have tried and has this improved or worsened your symptoms?*

Do you have any drainage coming from the affected area(s)?*

Yes

No

Are you experiencing pain in the affected area(s)?*

Yes

No

Do you have a fever or chills?*

Yes

No

Do you have weeping of fluid, crusting, or pustules (a small blister or pimple on the skin containing pus) on the affected area(s)?*

Yes

No

Please upload a picture of the affected area and make sure the entire body part is included. Do NOT send any images where the genitals or any reproductive organ is exposed.*

Drop files here or

Max. file size: 100 MB.

Provide a recent heart rate and blood pressure measurement. This can be from a recent appointment (within the past 6 months) or you can have these measured for free at most local pharmacies such as CVS or Walgreens.*

Finally, is there anything else we should know?*

Yes

No

Please briefly explain*

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