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07425 899611

Fungal Nail Infection Consultation

Fungal nail infections normally affect the toenails but can other times also affect the fingernails. The infection can appear on just one nail or several. The fungus makes the nails thicken, discolour, become distorted, brittle, and crumbly if no treatment is used.

1. About your Health

To help us understand that this treatment is the right option for you, please answer the following questions.

0%

Please state your gender

This refers to your biological gender

Male

Female

What is your date of birth?

Use the calendar to select your date of birth.

Please add your height (in cms)

Your height is important for the prescribers decision.

Please add your current weight (in kgs)

Please make sure to add your current weight. This may affect the prescriber's decision.

Do you have any recent or past medical history of note?

If so, please provide more information

Yes

No

Do you suffer from any allergies?

If so, please provide more information

Yes

No

Do you currently take any medication whatsoever?

Please list all your current prescription medication including any medication you buy over the counter.

Yes

No

Is there a history of medical disorder's within your family?

If so, please provide more information

Yes

No

Are there any other health/medical details you feel we should know?

If so, please provide more information

Yes

No

2. About your Condition

To help us understand that this treatment is the right option for you, please answer the following questions.

0%

Is this a repeat prescription?

Yes

No

Have you seen a health professional about your nail problem previously, and if so did they advise you it was a fungal nail infection?

Yes

No

Fungal nail infections cause nail thickening, nail discolouration, crumbling of affected nail when you try to trim it and a clear boundary (like a line) between the healthy nail (base of nail) and fungally infected nail (tip of nail) Are you reasonably sure your nail problem is a fungal infection?

Please Note: If you are not sure, you should see your GP or a community pharmacist to check.

Yes

No

Are 3 or more nails affected?

Yes

No

Do you have any other skin issues on your affected hand or foot, such as patches of red or inflamed skin?

Yes

No

Do you have any of the following health problems:

Diabetes
Impaired blood circulation
Immunosuppression (either from a disease such as HIV, or a medication such as steroids)

Yes

No

Are you breastfeeding, pregnant, or intending to become pregnant in the next 3 months?

Yes

No

Do you agree to see your GP, community pharmacist or podiatrist if:

Your nail condition worsens while using amorolfine lacquer, or there is no improvement after 2 months of treatment
Or the duration of your treatment reaches or exceeds 3 months

Yes

No

Have you ever had a skin reaction to a topical antifungal treatment, or an allergic reaction to an antifungal tablet?

Yes

No

Do you understand that you should not use nail varnish or artificial nails at any time during your treatment until the fungal nail infection has completely cleared?

Yes

No

Is there anything else which you feel we should know about prior to you taking this medication?

Yes

No

3. The Agreement and Consent

Please answer the following questions to help us confirm that you'll follow the guidelines for this medicine.

0%

Do you agree to the following?

You will read the patient information leaflet supplied with your medication
You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
The treatment is solely for your own use
You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.

Yes

No

I agree to the Terms and Conditions and I confirm that I am over 18.
Terms and Conditions

Yes

No

About Us

Profarma Direct is a cutting-edge online pharmacy that specialises in lifestyle medicine and personalised prescriptions.

Marsh House Lane, Darwen, Lancashire, BB3 3JB, United Kingdom
07425 899611
For Sales & Orders:
info@profarmadirect.com
For General Enquiry:
info@profarmadirect.com

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How to check GPhC Registration

You can check our pharmacy details and registration status here. You can also see details of any Fitness to Practise decisions relating to a registrant.

GPhC Registration Number:

2076639

GPhC Registered Owner:

Profarma Direct Ltd

Superintendent Pharmacist:

Zakaria Jalgaonkar

GPhC Pharmacy Details:

Marsh House Lane, Darwen, Lancashire, BB3 3JB, United Kingdom

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