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Dermatologist

Click or drag a file to this area to upload.
Give location, and particulars i.e.. is the rash itchy, bleeding, puss is coming out, dark red/brown/purple, more itchy at night, gets rash every winter (seasonal)
Have you had this skin problem before?
Example: East Asian , Caucasian
Gender
Approximate age
Locations on the body: (select all that apply)
Do you or your family have a history of skin condition? (select all that apply)
Have you recently done any of the following? (select all that apply)
Recent new exposures ? (select all that apply)
Duration of skin problem
Symptoms of skin problem? (select all that apply)
Any bleeding, crusting, or oozing from the area? (select all that apply)
Has the affected area changed in any way? (select all that apply)
Have you had any of the following symptoms? (select all that apply)
Example: aspirin 25mg twice daily 2 weeks. suntan lotion 1 week
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