Is this your first consultation?
Which part of the body is affected?
What are your skin concerns today? Please provide details in your own words.
When did you first notice your skin condition?
Have you already tried any treatment?
Has this happened before?
Does it itch?
Does it hurt (sore, tender or painful)?
Does it burn?
Does it tingle?
Does it bleed (without picking at it)?
Does it weep/ooze?
Is it hot to the touch?
Is it getting bigger/worse?
Is it getting smaller/better?
Have you developed any joint problems at the same time as this??
Does anyone else you've been in contact with have anything similar?
Are you currently unwell in any other way (eg with a fever, cold symptoms, cough etc)?
Have you been unwell recently and recovered?
Do you have any long term or recurring skin problems, like eczema or psoriasis?
Do you have any condition that might affect or suppress your immune system (e.g HIV, cancer, auto-immune disorders, transplants)?
Do you have any other health conditions?
Are you on any medication, even if you are not using that medication regularly?
Are you a smoker?
Do you have any drug allergies?
Do you have any non-drug allergies?
Are you currently breastfeeding, pregnant or trying for a baby?
Is there any additional information you would like to share?
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Zebra Health Technologies (Pty) Ltd
Unit G26, Plot 28562 Samora Machel Drive, Gaborone, Botswana