About the Condition and Treatment
To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.
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Are you the actual consumer of this medicine?
If not, please describe in detail who the intended consumer is and how old he/she is.
Do you relate to the following?
You are allergic or hypersensitive to Scopoderm.
Are you on any of the following treatments?
Antihistamines.
Do you experience any of the following problems?
Stomach conditions like Pyloric stenosis.
Do you have a history of using Scopoderm patches to treat your travel illness in the past?
If you do, how successful were they?
Do you consent to seeking further medical guidance in the following instances?
Acute and unexpected abdominal pains.
Are you experiencing any of the following signs and symptoms?
Constant vomiting for more than 48 hours?
Once you get home from travelling, do your symptoms last for more than one day?
Do you require assistance?
Is there a need for you to take motion sickness medication frequently?
Do you require assistance?
Have you experienced travel sickness for a long time or have you just experienced it recently?
Please select your option
Can you relate to any of the following?
You have an underlying medical condition
Can you relate to any of the following?
Your hair loss started recently, and you've lost a lot of hair in less than four weeks.
Hair loss has occurred in irregular spots on your head.
Your scalp is itchy or inflamed.
You've lost your hair as a result of your pharmacological treatment.
You're completely bald or have lost all of your body hair.
Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.
If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option
What is your biological gender?
Please select your option
Can we share this information with your General practitioner?
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.
Has the target user tried a different medicine to address the symptoms before?
If yes, what medicine was consumed and how effective was it?
For how long has the consumer of this medicing experienced these symptoms?
Please select your option
What symptoms do you intend to treat using this medicine?
Please provide more information
Can you relate to any of the following??
You have an underlying medical condition
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