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Acne Questions

You and your symptoms

Have you previously been diagnosed with mild to moderate acne by a medical doctor?


Do you or have you suffered from any heart problems stroke, angina or any other heart related problems ?


Are you taking any medication that has been prescribed by your Gp/Doctor or Hospital ?


Do you give consent for us to contact you GP if required? (we need this to process any order for medication)


Current Health

Are you pregnant, planning on becoming pregnant, or breastfeeding?


  • This treatment is not suitable for use in pregnancy. Treatment should be discontinued for at least one cycle prior to pregnancy.

Are you allergic to any of the following?


  • Adapalene
  • Benzoyl peroxide
  • Propylene Glycol

Do you currently have sunburn?


Are you taking any of the following medications?


  • Benzoyl Peroxide (a common ingredient in other skin preparations for acne)
  • Tretinoin, Adapalene, Isotretinoin or other retinoids.
Agreement

Do you understand that usage during pregnancy can cause birth defects and you must use effective contraception if there is a possibility you may become pregnant?


  • It is essential that you do not become pregnant while using this treatment. You must use effective contraception and stop using your treatment immediately if you forget to use your contraception. If you think there is a possibility of pregnancy, discontinue treatment and speak to your doctor immediately.

Do you understand that it can take 4-8 weeks of treatment before beneficial effects are seen?


Do you understand if your acne gets worse or starts to cause scarring, you must see your GP?


Do you understand that this medication can make your skin more sensitive to sunlight (photosensitivity)?


You should avoid sunlight and sunlamps while using this gel and take care to use sunscreen and cover in protective clothing if sunlight exposure is necessary.

Do you understand that treatment should not exceed 12 weeks?


Do you understand that you should use your treatment once a day, after washing your face with a mild cleanser and fully drying?


Do you understand that this medicine must not come in contact with eyes, mouth, mucus membranes, or eczematous/ broken/ sunburned skin, and that if it does by accident you should seek medical advice?


Do you understand that most people will experience some skin redness and peeling during the first few weeks of treatment?


If your skin becomes irritated, you may need to use an oil-free moisturiser, use your treatment less often, or stop using it for a short period to allow your skin to recover and then re-start treatment. If irritation persists or symptoms are severe, stop using the medication and contact our help desk or your GP.

Do you agree to the following statements?


  • You must read the patient information leaflet supplied with your medication
  • You must contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • The treatment is solely for your own use only.
  • You have answered all the questions in this short medical assessment accurately and truthfully to the best of your knowledge. You understand our doctor take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.
all of our tests and treatments are price competative

You need to complete our short medical questionnaire so we can ensure the treatment you have selected is safe for you to use

all of our tests and treatments are price competative

Need Help?

If you need help with this medical questionnnaire call us on 07549286701

 
quality products assured across youth revisited

Quality products

all of our tests and treatments are price competative

Affordable prices

all of our pharmacies and and treatments purchased are from well known and trusted UK pharmacies

UK pharmacy

all of our tests and any other products purchased will be dispatched for a next day service

Express next day delivery

If you have any further questions about any of our products please feel free to contact us and we will do our best to help you.
Once you have your prescription we will be able to process your order through our trusted UK Pharmacy.