Your Health
The information you provide us is treated with absolute confidentiality and will be reviewed by our experienced UK prescribers. We ask the following questions to provide the prescriber with an appropriate level of information to make an informed decision on whether the treatment is suitable or not.
What is your gender?
Please provide more detail.
Do you need help completing this questionnaire?
Please contact us on 020 7157 9759 or email [email protected] and we can assist you.
Do you believe that you have the capacity to make decisions about your own healthcare?
Sorry we can't offer you this treatment, please contact your GP.
Have you been diagnosed with any medical conditions?
Are you currently taking any medication? This includes prescription-only, over-the-counter and homeopathic medicines.
Do you suffer from any allergies?
Please provide details including which allergies and what symptoms you experience.
Is there anything else you would like to include to allow our prescriber to prescribe responsibly?
Medical Assessment
How long have you suffered from Acne?
Please give us much detail as possible. If your acne has previously disappeared and recently returned, please let us know.
Have you seen a medical professional face-to-face to diagnose your acne?
Please provide more information
Have you tried any acne treatments already?
Please list all treatments you have previously used
Please tell us which areas of your body are affected by acne.
Give us much detail as possible. For example, chin, cheek and T-zone is a preferred description than just saying "face"
Please select the type(s) of acne you suffer from.
Select one or more answer(s).
Do you suffer from any other skin conditions?
(e.g eczema, psoriasis, rosacea, perioral dermatitis)
Please upload a picture of your acne. If this is on the face, please include a picture showing the full face.
This is optional, however your order will be delayed if you do not upload a photo and you:
A picture will help our healthcare team to make an appropriate decision about your treatment.
Are you pregnant or breastfeeding?
Are you aware that oral antibiotics such as Lymecycline should not be taken whilst using Zineryt solution or Duac gel however oral antibiotics for acne are best used with items such as Differin, Epiduo or Benzoyl Peroxide gels.
This advice is to reduce the chance of antibiotic resistance.
Do you agree to consult your doctor in the following circumstances?
Consent
Would you like us to notify your GP of the treatment you chose to order today?
Please provide details.
It is very important that your GP is aware of all the medication you are taking, so that you are receiving the best possible care. You should only select “no” if you are completely sure you do not wish us to tell your GP.
Do you agree to the following:
If treatment is not suitable, you will be fully refunded and signposted to another point of care. The decision about the treatment is for both the patient and the prescriber to consider, however, the final decision will always lie with the prescriber.
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