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Before ordering, please fill in the consultation form, in order to have your Clinic file & to follow your improvement.

 
   
     
 
Clinic file
Name:
Age:
Gender:
Occupation:
Address:
City:
State:
Country:
Phone:
Email:

How long have you ever been suffering Psoriasis?

Please let us know the type of Psoriasis determined by your Dermatologist.

Specific symptoms & signs you have.

Silvery white scales

Itching

Vesicle

Pustule
Papula Eritomatosa
Scab varnish style
Hypocromic spot

Detached fine scales

General malaise

Fever

Location:  

Face & neck

Scalp
Hands
Body trunk
Axilla, groin & genitals
Legs & feet

Additional comments:

A low resolution picture of your lesions could be necessary (optional)

Please be sure you answer all the questions required and then click send