Your Health

About You

1

Do you believe you have the capacity to make decisions about your own health; and that you do not require help to complete this consultation? *

2

What is your height? *

3

What is your weight? *

Your symptoms

4

How do you know that you have a fungal nail infection? *

5

Have you used any fungal nail treatment(s) before? *

6

Which areas are affected? *

7

How many nails are affected in total? *

8

What is the appearance of your nail(s)? *

9

Do any of the following apply to you? *

  • Your nail is bleeding, oozing or has ulcers
  • There are warts growing under your nail, or on the sides of the nail
  • Pitting on the nails, similar to multiple pin pricks on the surface of your nail
  • Your nail is black/purple/green
  • Your nail has stopped growing
  • Your whole nail is yellow and has stopped growing

10

Do you have any allergies to amorolfine, or any of the ingredients contained in amorolfine nail lacquer, or any other allergies? *

11

Do you understand that you should see your GP if there is no improvement after 2 months of use or if your nail infection gets worse? *

Your health

12

Are you pregnant, breastfeeding, planning pregnancy or at risk of pregnancy whilst using amorolfine? *

Pregnancy risk may be defined as late period or unprotected sexual intercourse which may have taken place since your last normal period.

13

Do you have any of the following? *

  • Psoriasis
  • Diabetes
  • Compromised immune system
  • Poor blood circulation
  • Skin infection
  • Damage or pain around the skin of your nail

Agreement

14

Is there any additional information you would like to provide, or any questions you have? *

15

Do you understand that? *

  • You should keep nails trimmed short and filed down. Avoid sharing toenail clippers with family members.
  • You should wear well-fitting non-occlusive shoes, without high heels or narrow toes. Consider replacing old footwear which could be contaminated with fungal spores.
  • You should wear cotton, absorbent socks.
  • You should maintain good foot hygiene, including prompt treatment of any associated areas.
  • You should wear protective footwear when using communal bathing places, locker rooms, and gymnasiums, to avoid re-exposure.
  • You should avoid prolonged or frequent exposure to warm, damp conditions if possible, and avoid trauma to the nails if possible
  • You should read The British Association of Dermatologists information leaflet Fungal infections of the nails and the NHS information on Fungal nail infection
  • You should continue treatment for 6 months for fingernails and 9–12 months for toenails, ensuring to apply the lacquer to the whole area affected
  • You should avoid cosmetic nail varnishes, artificial nails and the use of other topical treatments during treatment
  • You should avoid contact with the ears, eyes, and mucous membranes

16

Do you understand that? *

  • You must read the Patient Information Leaflet supplied with your medication
  • You must contact us and inform your GP if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • You should be over 18 and the treatment is solely for your own use
  • You must have answered all the above questions accurately and truthfully and that incorrect information can be hazardous to your health
  • You are aware the decision about your treatment are for both the prescriber and yourself to jointly consider during this consultation, but the final decision will always be the prescriber's.
  • By continuing, you agree to our Terms & Conditions, Privacy Policy and Cancellation Policy