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Male Female Other

    1 - How often do you have episodes of excessive sweating?*

  • Less than once a week
    A few times a week
    Every day
    Multiple times a week
  • 2 - Where do you have excessive sweating?*

  • Armpits
    Palms of hands
    Soles of feet
    Face
    Scalp
    Groin
    Other
  • 3 - How old were you when you started having episodes where you sweat excessively?*

  • Under 18 years old
    19-25 years old
    26-30 years old
    Over 30 years old
    I don't remember
  • Radio Group

    4 - For the body parts affected, do you experience sweating on both sides of your body (for example, both armpits or both palms of hands) or only on one side?*

  • Both sides
    Only one side (only my right side or just my left side)
  • 5 - What triggers your excessive sweating?*

  • Heat
    Stress or anxiety
    Spicy food
    Alcohol
    Physical activity
    Other
    I'm not sure (or it seems random)
    My symptoms occur all day, every day
  • 6 - When do you usually experience an episode of excessive sweating?*

  • Only during the day
    Only at night
    Both day and night
  • 7 - "Do you sweat at rest? "*

  • Yes
    No
  • For example, if you’re sitting at dinner with family or friends, do you notice that you’re the only one sweating?

    8 - Have you ever talked to a doctor about your excessive sweating before?*

  • Yes
    No
  • 9 - What treatments have you previously tried for sweating?*

  • Regular strength antiperspirant/deodorant
    Clinical strength antiperspirant/deodorant
    Prescription products
    Lotions
    Wipes
    Other
    None
  • 10 - Was your past treatment effective?


  • Please also list the medication names and how long you used them (or if you are still using them). If you haven't tried any treatments, you can leave this question blank.

    11 - "Have you ever had any procedure for sweating? "*

  • Botox injections
    Surgical procedure to remove sweat glands
    No-sweat machine (iontophoresis)
    Microwave thermolysis
    Other
    No, I have not had any of these procedures
  • For example, Botox injections, surgical or laser procedures, etc.

    12 - Do you have any other skin conditions besides excessive sweating?*

  • Yes
    No
  • 13 - Do you have any family members who have also suffered from excessive sweating?*

  • Yes
    No
  • 14 - Are you currently breastfeeding, currently pregnant, or may become pregnant?*

  • Yes
    No
    Not Sure
  • 15 - Do you have (or have you ever been diagnosed with) any of the following conditions?*

  • Diabetes
    Thyroid issues (overactive or underactive)
    Cancer
    Pituitary tumor
    Adrenal tumor
    Tuberculosis
    HIV
    Other chronic conditions
    None
  • 16 - Please list any additional medical conditions, surgeries, or hospitalizations you have had.


  • 17 - Are you currently experiencing any of the following?*

  • Rash or other skin issues anywhere else
    Fever or chills
    Heart palpitations
    Cough
    Swollen and/or painful glands
    Fatigue
    Losing weight without trying intentionally
    More thirsty than usual
    Urinating more frequently than usual
    None of these apply to me
  • 18 - Are you currently taking any of the following medications (or have you taken any within the past 2 weeks)?*

  • Medication for diabetes (e.g. metformin, insulin)
    Thyroid hormone replacement (e.g. Synthroid)
    SSRIs (antidepressants)
    Birth control pills
    NSAIDs, e.g. naproxen (Aleve®), ibuprofen (Advil®)
    I am not taking any of these medications
  • 19 - Do you take any medicines, vitamins, or supplements?


  • Include any topical skin creams or ointments (both over-the-counter such as Jergens, Cetaphil, etc, and any prescription topicals you may be using). Include any medicines (e.g. Lipitor, Zyrtec, ibuprofen), herbs, vitamins, or dietary supplements that you have taken in the past two weeks, even if you are not taking them today.

    20 - Please list any allergies you have.


  • Include any allergies to food, dyes, medications (including prescription medications and over-the-counter medications), insect venom, herbs, vitamins, supplements, and anything else.

    21 - Is there anything else related to the treatment that you'd like to ask or discuss with your medical provider?


  • 22 - Do you have a preferred treatment?*

  • No preference
    Drysol® (20% aluminum chloride hexahydrate)|
  • Don't worry if you're not sure. Your doctor will help you pick the best one for you.

    23 - Please enter preferred pharmacy information.*


  • Include a complete information where you would like to pick up your medication.

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One Time Consulting Charges: $49.99 (USD)

The above payment is for consultation only and does not cover the cost of your medication. Top Health Center will only send your prescription to your pharmacy of choice.

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