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Primary skin condition (tick all that apply)
Areas affected (tick all that apply)
Impact on quality of life
Treatment confirmation
Medical history (tick all that apply)
Mental health screening (past 6 months: tick all that apply)
Medicine declarations
Pregnancy capability (for MHRA PPP assessment)
Current contraception method(s) (tick all that apply)
PPP understanding (tick all that apply)
Pregnancy testing declaration (tick all that apply)
Patient acknowledgements (tick all that apply)
Consent
Clear Signature