We're delighted you'd like to join Eczema Outreach Support. Please complete the following form which should only take a couple of minutes.

Your Details

Questions

Do you care for a child who is under 18 and has a diagnosis of eczema?

Are you the main carer?

Do you live in the UK?

Unfortunately we are unable to offer our services to parents/carers outside the UK or parents/carers with a child with eczema aged 18 and over.

Eczema Outreach Support is a charity supporting families in the UK struggling with the day-to-day challenges of having a child with eczema.

If you are unsure about your child’s diagnosis or you need specific medical advice please speak to your GP in the first instance.

Your Details

First Name

Last Name

Mobile

Home Telephone

Address Details

Address Line 1

Address Line 2

Town/City

Post Code

Additional Information

Where did you hear about us?

Would you like our parent/carer booklet in a different language?

Your relationship with the child/children with eczema?

If other, please specify

Anything additional you wish to notify us of about your child's Eczema

Child Details

First Name

Last Name

Date of Birth

Sex

How is your child's Eczema?

What treatments is your child using or has tried?

Use Ctrl or CMD to select multiple values

Privacy Statement

We are committed to respecting any personal data you share with us, to keep it safe and to not do anything with it that you would not reasonably expect. We only ask for information that allows us to provide services to you or to gather relevant information to campaign for better support for children living with eczema and their families. We do not share your information without your consent and we never share your data for commercial purposes. You can at any point contact EOS and ask for your data to be removed. See our full Privacy Statement here

I understand and agree with the statement

Contact Information