Medical Assessment for Nail Infection

To help us supply you with the most suitable treatment, please complete this online consultation.

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About You

Are you aged between 18-80?

Yes

We are unable to supply you with treatment. Please consult your GP or doctor.

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Are 3 or more nails affected?

Yes

You should contact your GP to seek advice on the best treatment when multiple nails are affected.

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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?

Yes

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

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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

Please confirm diagnosis with a health professional (e.g. GP, community pharmacist or podiatrist)

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Your Health

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

Yes

Fungal nail infections are not dangerous to your health. It is safest for your baby if you wait until you have completed your pregnancy and/or breastfeeding before you start treating your nail.

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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

Since not all nail problems are fungal, if your nail problem worsens on treatment, or fails to respond, it would indicate you should see an appropriately qualified professional to check the diagnosis. Please change your answer and continue.

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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

If you have any of these problems, it is advisable you seek treatment from a doctor rather than a pharmacy

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

Yes

Some nail problems are secondary to conditions such as psoriasis or severe eczema. Please check with a GP or community pharmacist.

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

Yes

We are unable to prescribe you Amorolfine as there is a risk of a further allergic reaction. Please speak to your GP.

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Agreement

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

It is unknown whether the solvents in nail varnish and glue may interact with treatment so the manufacturer strongly advises against use of these alongside treatment.

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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, you start new medication and/or 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
You understand that whilst decisions relating to your treatment are made jointly between you and the prescriber, the final decision to issue a prescription will always be with the prescriber

Yes

You must agree to this before continuing. If you need assistance contact our customer support.

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Medical Assessment for Nail Infection

To help us supply you with the most suitable treatment, please complete this online consultation.

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