Athlete’s foot consultation

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Name *

First

Last

Date of birth *

Email *

Phone *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

What are the symptoms you are experiencing? *

Itching and burning sensation: Often between the toes or on the soles of the feet.
Red, scaly rash: Typically appears between the toes and may spread to the rest of the foot.
Cracked, peeling skin: Especially between the toes or on the soles of the feet
Blisters: Small, fluid-filled blisters may develop.
Dry, flaky skin: Common on the soles or sides of the feet.
Thickened, discolored toenails: In more severe cases, the fungus may spread to the toenails, causing them to become thick and yellow.
Unpleasant odor: A noticeable smell may accompany the infection

How long have you experienced these symptoms? Select one answer *

1-3 days
4-7 days
8-14 days
Long term (Have seen GP)
Long term (Have not seen GP)

We’re sorry, but there are no suitable treatments for you.

The safety and well-being of our patients is our number one priority, and based on your answers, we can’t recommend any of our treatment options. We know this is both frustrating and disappointing, but we want to make sure that we’re putting your health first and that you find the right care.

If you’d like to speak to our clinicians about this, please email info@medicalmojo.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Do you suffer from any of the following:

Diabetes
A compromised immune system
Poor blood circulation in the extremities

Athlete's foot red flags *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email info@medicalmojo.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Are you aware that you should see your GP if

You infection hasn’t improved after using antifungal medicine for 2 weeks
You have a weakened immune system – for example, from chemotherapy, steroids or diabetes

Confirm GP follow up *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email info@medicalmojo.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Have you tried anything already to treat the condition? *

What treatments have you tried? *

Was the treatment effective? *

Did you experience any side effects when using this? *

Please can you tell us what the adverse effects were? *

What is your biological sex? *

Male
Female

Are you pregnant, breastfeeding, or trying for a baby? *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email info@medicalmojo.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Do you have any other medical conditions not already mentioned? *

Please provide more details *

Are you taking any other medications that have not already mentioned? *

Please share details of any other medical conditions you have and any medications you are currently taking. Be sure to include the name of each medication, the dosage, and how long you’ve been using it

Other medication *

Do you have any other allergies that you have not previously mentioned? *

Please give us more details on these allergies *

Do you agree and consent to the following?

I am at least 18 years old and live in the UK.
I have the capacity to make decisions about your own healthcare
I shall be the sole user of any medication offered to me through this service.
I confirm all answers are provided by me and are truthful.
You understand the prescriber will take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
If prescribed a treatment, I will read the Patient Information Leaflet (PIL) that will be provided.
If prescribed a treatment, I will inform my GP of my treatment and contact them if I have any side effects associated with the treatment.
You agree to our terms and conditions, privacy policy and acceptable use policy
You are aware you will be subject to a soft check to validate your identity using LexisNexis.

Checkboxes *

I agree to the statements and give my consent for any treatment provided.

Are you registered with a GP in the UK? *

(Optional) Do you consent to us accessing your NHS Summary Care Record (the medical details held by your GP) or requesting further information on your medical history from your GP?

Summary care records

I consent

(Optional) Do you give us consent to write to your GP to share information of this supply and any information we hold about you?

Send information to GP

I consent

Product Category

Important

We review all orders to ensure they’re the best treatment we can offer you. If what you ordered is unsuitable, we will refund part or all of your order.

If we decide what you ordered is unsafe for you, given the other information you provided, we won’t issue any treatment. However, we may call you and suggest alternatives.

Athlete’s foot consultation

Do you agree and consent to the following?

Conditions

Treatments

Care and policies