Excessive Sweating Consultation

Our pharmacists require complete and accurate answers in this consultation to provide recommendations on medications which may include prescription medications.

In the interest of safety please answer all questions honestly, candidly and correctly.

Before completing the excessive sweating consultation, please confirm the following statements:*

I have seen the following healthcare professionals about my excessive sweating? (check all that apply)*

General Physician/Family Doctor

Dermatologist

Surgeon

Herbalist/Naturopath

None

Other

If other, please specify:

Patient Information:

Name*

Email*

Phone Number*

Country*

Sex*

Birthdate*

Weight (kg)*

Please enter a number greater than or equal to 0.

1 kg = 2.2 lbs

Height (cm)*

Please enter a number greater than or equal to 0.

Please indicate if any of the following apply to you?

Pregnant

Planning to become pregnant

Breastfeeding

Menopause

Please list any other medical conditions you may have (leave blank if none).

Please list any medications you are taking and what they are being used for: (prescription & non-prescription medications, OTCs, herbals, vitamins/minerals, supplements, inhalers, topicals, patches, eye/ear/nose drops)

Prescription Medications

Prescription Medications (Drug Name)

What is it used for

Prescription Medications (Drug Name)

What is it used for

Over the counter Medications

Over the counter Medications (e.g Tylenol, Advil)

What is it used for

Over the counter Medications (e.g Tylenol, Advil)

What is it used for

Vitamins, Minerals, Supplements, Other

Vitamins, Minerals and Supplements

What is it used for

Vitamins, Minerals and Supplements

What is it used for

Do you have any Medication Allergies?*

Yes

No

If yes, please list the medication(s)*

If yes, please list the medication(s)

How long have you been dealing with Excessive Sweating?

Please enter a number greater than or equal to 0.

(years)

Which products have you tried in the past?

Product Name

Did it help?

Yes

No

A little

Are you still using?

Yes

No

My Sweating can be best described as: (check all that apply)

Mildly damp (clammy)

More than clammy

Beads of sweat when at rest

Dripping when at rest

Steady

Sporadic

Triggered by events/situations

Triggered after eating certain foods

Occurring independent of temperature

Any additional questions or comments you would like to leave?

Name

This field is for validation purposes and should be left unchanged.

Medical Information