Consultation

Please read the Agreement and Consent statements carefully during your consultation. They contain important information to help you stay informed and safe throughout your treatment.

Understanding of Risks

I have been informed about the potential side effects and interactions of the prescribed medication for acne.

Medical Guidance

I agree to consult with my healthcare provider before starting any new medication.

I understand that the information provided in this assessment will be reviewed by a licensed pharmacist before my order is processed.

Consent to Share Information

I consent to my personal and medical information being used to assess my suitability for the prescribed medication.

I understand that my information will be kept confidential and used solely for the purpose of this assessment.

Confirmation

I confirm that the information provided in this assessment is accurate and complete to the best of my knowledge.

I understand that providing false information may result in my order being cancelled and may have health implications.

Assessment for Acne

Acne

1 About Your Condition

How long have you been experiencing acne?

Have you consulted a healthcare provider about your acne?

Yes

What type of acne do you have? (e.g., blackheads, whiteheads, papules, pustules, nodules, cysts)

How often do you experience acne breakouts? (e.g., daily, weekly, occasionally)

Are there specific triggers that worsen your acne? (e.g., certain foods, stress, hormonal changes)

Yes

Have you been prescribed medication for acne before?

Yes

Are you currently taking any medication for acne?

Yes

Have you experienced any side effects from your current or past acne medications?

Yes

Have you tried any non-medication treatments for acne? (e.g., topical treatments, lifestyle changes, dietary modifications)

Yes

Have you used over-the-counter acne treatments?

Yes

Are you currently taking any medications?

Please provide more information.

Do you have any known allergies?

Please provide more information.

2 The Agreement and Consent

Understanding of Risks

Medical Guidance

Consent to Share Information

Confirmation

Assessment Progress

Quick Links