• Important
  • Acne
  • Health
  • Medicines
  • Consent
  • What happens next
Our doctors would now like to check your suitability for this product

How did you hear about us?

I confirm the above statements are true This questionnaire forms the basis of your online consultation. Please be honest and if you are unsure about any of your answers, please verify the information with your GP before using the service:

--I am 18 years old or above.
--I am using this service on my own behalf and of my own free will. Any treatment or advice is for my sole use only.

Please confirm that you understand this We try our best to help our patients, but sometimes our online service is not able to meet all of your needs. If you need help filling out forms, reading, writing or understanding complicated information, or your acne is severely affecting your mood and self-confidence, then please see your GP.

As part of our service we will need at least two photos which clearly show the acne, so we can give you advice. We may suggest treatments that you can choose to purchase online, or we may refer you back to your GP if we feel treatment online is not the best option for you.


We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

About your acne

How long have you had acne?

Where is your acne?

Which of the following describe your acne?

Does your acne leave scars when it heals?


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Current and previous acne treatment

Are you currently receiving treatment for your acne?

Have you received treatment for your acne in the past?


Your preferences regarding acne treatment

Are there any treatments you are particularly interested in receiving for your acne?

Are there any treatments you do not wish to receive due to side effects or poor results?


We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

Your general health

Have you any other skin problems such as eczema, broken and damaged skin or a photoallergy?

Have you ever been diagnosed with a liver condition?

Have you ever been diagnosed with a kidney condition?

Do you have galactose intolerance, glucose-galactose malabsorption, or Lapp lactose deficiency?

Please confirm your gender

Do you smoke?


Your height and weight

Please enter your height(cm).

Please enter your weight(kg).


We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

Current and recent use of medicines

Are you taking any prescription-only medicines, over-the-counter medicines, alternative medicines or recreational drugs?

In the last two months have you taken any medicine, including both prescription and non-prescription medicines, other than any medicine you have mentioned above?


Allergies

Are you allergic to any of the following? Please select all that apply.

Do you have any other known allergies?


We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

Informed consent

I confirm the all We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

Permission for photographs use Providing such use renders the photograph(s) completely anonymous, I give my permission to the online doctor to use the photograph(s) for training, teaching, research or commercial purposes. This would include use on Online Doctor and associated partner websites.

I confirm the all -- I have responded honestly and provided complete and accurate information that reflects my up to date medical history and information, so that the doctor can safely assess and advise me.
-- I fully understand all the questions and information provided. If I am unsure about any aspect of the service I will contact Your Chemists Online Doctor before proceeding.
-- I understand the side effects, effectiveness and alternatives to the treatment I am requesting.
-- I understand this consultation will form part of my Online Doctor medical record and will be kept in line with the relevant retention period.
-- I have read, understand and agree to the latest terms and conditions and privacy policy.


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