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Aron Regimen One Year Feedback Form
What is the current age of the patient?
Patient Age
Patient Age
At what age did the patient first show symptoms of eczema?
Patient Age
Patient Age
What medical professionals had the patient consulted in the year PRIOR to consulting with Dr Aron?(check all that apply)
Other
In the year PRIOR to consulting Dr Aron had the patient had any skin swabs performed?
If YES what was the result?
How long has the patient been using the Aron Regime for?
PRIOR to starting the Aron Regime did the patient have any confirmed allergies?
(Confirmed with a positive blood test or skin prick test.)check all that apply
Other
PRIOR to starting the Aron Regime HOW MANY confirmed allergies did the patient have?
(confirmed with a positive blood test or skin prick test)
How many of those allergies have resolved since being on the Aron Regime?
In the year PRIOR to starting the Aron Regime, did the patient show symptoms of other atopic conditions?check all that apply
Other
Since using the Aron Regime have the symptoms of the other atopic conditions changed in severity?
If YES please explain
What TOPICAL therapies were used / tried in the year PRIOR to starting the Aron Regime?check all that apply
Other
In the year PRIOR to the Aron Regime what type and strength of steroid or immunosuppressant creams / ointments did the patient use?if possible please list names and strengths (% or mg/ml)
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What ORAL medications or therapies were used / tried in the year PRIOR to starting the Aron Regime?check all that apply
Other
In the year PRIOR to starting the Aron Regime, how frequently did the patient use a course of TOPICAL ANTIBIOTIC medication?
Other
In the year PRIOR to starting the Aron Regime, how frequently did the patient use a course of ORAL ANTIBIOTIC medications?
Other
In the year PRIOR to starting the Aron Regime, how frequently did the patient use TOPICAL STEROID medications?
Other
In the year PRIOR to starting the Aron Regime, how frequently did the patient use ORAL STEROID medications?
Other
In the year PRIOR to starting the Aron Regime, how frequently did the patient use TOPICAL IMMUNOSUPPRESSANT medications?
Other
In the year PRIOR to starting the Aron Regime, how frequently did the patient use ORAL IMMUNOSUPPRESSANT medications?
Other
AT PRESENT whilst using the Aron Regime, what additional TOPICAL therapies or medicines are being used ? (other than the compounded cream)check all that apply
Other
AT PRESENT whilst using the Aron Regime, what additional ORAL therapies or medicines are being used ?check all that apply
Other
Approximately how many moisturisers / emollients did the patient try in the year PRIOR to starting the Aron Regime?
In the year PRIOR to starting the Aron Regime, approximately how many times a day was the patient applying moisturiser or emollient?
AT PRESENT whilst using the Aron Regime, how many times a day does the patient use moisturiser or emollient (other than the compounded cream)?
In the year PRIOR to starting the Aron Regime did the patient need to wear any special clothing?(e.g. eczema suits / clothing, medical silk, scratch mitts, swaddles etc....)
AT PRESENT whilst using the Aron Regime does the patient need to wear any special clothing?(e.g. eczema suits / clothing, medical silk, scratch mitts, swaddles etc....)
In the year PRIOR to starting the Aron Regime did the patient use any wet wrapping or bandages?
AT PRESENT whilst using the Aron Regime, does the patient need to use any wet wrapping or bandages?
In the year PRIOR to starting the Aron Regime how many days did the patient miss of nursery, school or work because of the eczema?(missed due to 'sick days' or doctors / hospital appointments)
Since using the Aron Regime how many days has the patient needed to miss of nursery, school or work because of the eczema?(missed due to 'sick days' or doctors / hospital appointments)
In the year PRIOR to starting the Aron Regime how many days was the patient admitted to hospital as an urgent or emergency case because of their eczema?
Since using the Aron Regime how many days has the patient been admitted to hospital as an urgent or emergency case because of their eczema?
Whilst using the Aron Regime has the antibiotic component ever been removed from the compounded cream?
If YES at what stage of treatment was the antibiotic removed?
Years
Months
Currently how often is the compounded cream applied?
Other
Have you noticed any of the following changes since starting the Aron Regime?check all that apply
Other
In the patients / carers own words please explain how the Aron Regime has differed from other therapies they have tried.In the patients / carers own words please explain how the Aron Regime has differed from other therapies they have tried.
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If you are interested in being contacted to be involved in further questionnaires and studies please supply an email address in the box below.
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