Dermatitis Mif – GoodpillRx

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

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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

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

Search in title

Search in content

Search in content

Search in excerpt

Post Type Selectors

product

product

post

post

page

page

product variation

product_variation

Filter by Categories

Uncategorized

Uncategorized

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

Contact 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? (Lbs)*

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.*

Where on the body are you experiencing irritation?*

Face

Neck

Chest

Arms

Legs

Back

Hands

Feet

Buttocks

Genitals

Other

Please specify.*

When did the irritation start?*

The following are common triggers for contact dermatitis: Please select all that apply to you.*

Excess water

Detergents/surfactants

Solvents

Oxidizing agents

Alkalis

Metal tools

Wood

Fiberglass

Plant parts

Paper

Dust

Soil

Occupation

Other

Please specify.*

Please provide details from your occupation that may have caused your symptoms.*

Are you experiencing any of the following symptoms? Select all that apply.*

Pain

Burning

Stinging

Itching

Dryness

Redness

Blisters (fluid filled bumps)

Swelling

Other

None apply

Please specify.*

Have you been diagnosed with any of the following?*

HIV/AIDS

Parkinson Disease

Psoriasis

Ezcema

Skin cancer

None apply.

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

Have you previously been treated for this condition?*

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?*

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?*

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.

Finally, is there anything else we should know?*

Yes

No

Please briefly explain*

GoodpillRx is dedicated to helping our patients have access to quality, affordable medications, delivered straight to their door.

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