Have you seen a health professional about your nail problem previously, and if so did they advise you it was a fungal nail infection?

Fungal nail infections cause nail thickening, nail discolouration, crumbling of affected nail when you try to trim it and a clear boundary (like a line) between the healthy nail (base of nail) and fungally infected nail (tip of nail) Are you reasonably sure your nail problem is a fungal infection?

Are 3 or more nails affected?

Do you understand that you should not use nail varnish or artificial nails at any time during your treatment until the fungal nail infection has completely cleared?

Do you agree to the following?

You will read the patient information leaflet supplied with your medication You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment. The treatment is solely for your own use You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.

Do you have any other skin issues on your affected hand or foot, such as patches of red or inflamed skin?

Do you have any of the following health problems:

Diabetes Impaired blood circulation Immunosuppression (either from a disease such as HIV, or a medication such as steroids)

Are you breastfeeding, pregnant, or intending to become pregnant in the next 3 months?

Do you agree to see your GP, community pharmacist or podiatrist if:

Your nail condition worsens while using amorolfine lacquer, or there is no improvement after 2 months of treatment Or the duration of your treatment reaches or exceeds 3 months

Have you ever had a skin reaction to a topical antifungal treatment, or an allergic reaction to an antifungal tablet?