General skin condition

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General skin condition
This form is designed to help assess skin conditions that may need further medical attention. Please complete this form with as much detail as possible about your symptoms, including how long you’ve had the condition, any treatments you’ve tried, and how the condition affects you.

Many mild skin conditions improve with time or over-the-counter treatments. If your symptoms are not worsening, consider trying a topical cream or consulting your local pharmacist.

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I understand that my GP Surgery will only receive my consultation if I have completed it in full and have clicked "Finish" at the end.

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I agree to my data being stored, shared, and used for further communication in accordance with the privacy policy which can be found here for Bramley, Middleton, and Cottingley, here for Briercliffe GP Surgery, here for Gateshead Healthcare, here for Queens Medical Centre and Lynton, here for the Mayflower Group, and here for Coleridge.

4. To ensure you receive the right care, we work with clinicians across the NHS, including local pharmacies. This means that your econsultation may be reviewed by a local pharmacist working for a local pharmacy or by one of our own staff members who will call you to discuss further if needed. For more information, click here. Please accept the following. *

I confirm that I am happy for either a clinical pharmacist from a local pharmacy or a clinician from my GP Surgery to contact me regarding my econsultation.

5. All subsequent questions during the online consultation are directed at the person requiring the online consultation. You should only complete this consultation for: a) yourself, (b) for someone else where you have their permission to do so, (c) for someone else where you are permitted in law (for example, a parent or guardian, carer, someone with power of attorney). Please indicate who you are completing this online consultation for: *

Myself
Someone else (I have parental responsibility or I am a carer)
Another person (with their permission or allowed in law)

1. Econsultation reason:

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3. Please confirm that you agree to our privacy and data sharing policy. *