Skin Rash & Eczema

What best describes the symptom that you're seeking help for today?

Where are you experiencing these symptoms?

Are there additional places where you are experiencing symptoms?

How long have you experienced these symptoms?



Is there anything that seems to make your symptoms occur more often?

How many times per year do you notice these symptoms?







Do any family members ever get a similar type of rash?

Have you tried any treatments in the past? If yes, what was the treatment and was it successful?

Is there anything else related to treatment that you'd like to ask or discuss with your medical provider?

Do you have a preferred treatment?

Would you like to share anything else with your provider through an upload?

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Do you want to cancel the visit?