Acne Survey

    Acne

    Choose your Location

    What is your date of birth?

    Which parts of your body are affected?

    Please specify

    When did the acne breakout start?

    Have you already tried any treatment for it?

    Enter medicine including name, dose and dosage form

    Do you have acne blemishes (zits, pimples, whiteheads, blackheads) for at least 4 weeks or longer?

    What does your acne look and feel like?

    Please specify

    In women, acne may be caused by a hormonal condition. How often do your periods occur?

    Tell us more. How long have you had this? Have you seen a doctor for this?

    Are you allergic to any medicine?

    Please list your drug allergies and what happens when you use that drug.

    Do you take other medication(s) or have any other medical conditions?

    Please include any antibiotics, name of birth control, as well as any over-the-counter and herbal dietary or potassium supplements.

    In order for us to provide you with the best care, please let us know what medications you take and what conditions you have.

    Do you have any of these conditions?

    Please specify

    Anything else you would like us to know?

    Tell us about any concerns or questions you have for the medical team.

    How would you like to pay?

    upload emirates insurance details (if available)

    Billing and delivery details

    Google Map: (Please Share your Google Map Link)
    Delivery Location
    Neighborhood/Area:
    Street Name/No:
    Address Details:

    Upload photos of your skin

    Our medical team will review your photos to better understand your skin concerns and recommend the best treatment. Their ability to diagnose your condition might be limited by the quality of your pictures.

    Personal Details

    Title:
    First Name: Last Name:
    Date of Birth:
    Mobile Number: E-mail:

    Confirm Request and Agree to Terms