Welcome to our online excessive underarm sweating preliminary assessment

Is the patient pregnant? *

YesNo

Is the patient breastfeeding? *

YesNo

Is the patient planning a pregnancy in the next 12 months? *

YesNo

Unfortunately, Botox is not a suitable treatment for you. Please close this screen and see your GP for further guidance.

Please note that Botox should not be used within 3 months of the start of trying for a pregnancy

How long have you been experiencing excessive armpit sweating for?

Have you ever seen your GP about your excessive sweating?

YesNo

Have you ever seen a dermatologist about your excessive sweating?

YesNo

Have you previously tried anti-perspirants containing aluminium chloride hexahydrate and either a) failed treatment with this or b) developed itching, redness or irritation? *

YesNo

Have you had treatment with Botox for your armpit hyperhidrosis in the last 4 months performed by a dermatologist, neurologist or paediatrician? *

YesNo

Unfortunately, you are not eligible for a Medicare rebate on your Botox treatment.

Some medications can cause or excacerbate hyperhidrosis. Please list any medication you take.

Please list any medical conditions you may have.

Excessive armpit sweating can cause significant social distress and can have a great impact on one's self-esteem

Does your underarm sweating cause you embarrassment?

YesNo

Are you selective about the type of clothing you wear because of your condition?

YesNo

Do you avoid certain activities because of your excessive sweating?

YesNo

Do you go out of your way to hide your excessive sweating problem?

YesNo

Does your excessive sweating produce an unpleasant odour?

YesNo

The next few questions assess whether or not you need further medical tests before being considered for treatments.

Has anyone in your family experienced excessive sweating?

YesNo

Does your sweating continue at night when you are sleeping? I.e. do you wakeup in a pool of sweat under your armpits?

YesNo

Have you been losing weight unintentionally?

YesNo

Do you experience any chills or shaking at night?

YesNo

Do you experience excessive sweating in other areas besides your underarms?

YesNo

Please elaborate

Based on your selected answers, it is important that you are further evaluated by your GP or a dermatologist as soon as possible, as your sweating may be due to a serious medical condition. Please discontinue this questionnaire and make an appointment to see your GP.

Declaration

I confirm that all the information I have provided is true and accurate *

YOUR ELIGIBILITY

Based on the answers you have provided, you are eligible for Medicare subsidised axillary (armpit) hyperhidrosis treatments with Botulinum toxin.

The cost for an initial appointment and treatment with 100 units of Botox (50 units to each armpit) for PBS Botox is as follows;

FIRST VISIT	Fee Payable on the day of service	Medicare Rebate (with a valid referral from your GP)	Out of pocket
Initial Consultation	$355	$81.30	$273.70
Botox Injections	$510	$230.85	$279.15
TOTALS	$865	$312.15	$552.85

SUBSEQUENT VISITS	Fee	Medicare rebate	Out of pocket
Dermatologist attendance	$40.85	$40.85	$0
Botox Injections	$510	$230.85	$279.15
TOTALS	$550.85	$271.70	$279.15

- All fees are subject to change

- Fees above are for online bookings for treatments with Dr Chris Jalilian only

- A referral from your GP is required to receive a Medicare rebate

- All fees are payable on the day of service

To proceed to make an appointment, please hit 'Next'

Schedule your appointment with Dr Chris Jalilian (Dermatologist)

Select Your Appointment Date & Time *

Appointment location: G3/1165 Stud Road, Rowville, 3178

Please Confirm Your Details

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