What is your date of birth?

Have you used any of the following skin lightening medications or therapies?

Do you have any family history of skin cancer?

If yes, please tell us more (Who? What kind of skin cancer? At what age?)

Where are the dark spots (hyperpigmentation) on your skin that requires treatment?

Please list the names and reasons for any medications or over-the-counter skin products you are currently using.

Do you suffer from any of the following conditions?

Certain symptoms can be a sign of skin conditions that wouldn't respond to our treatment, and it would be more appropriate to see a doctor in person rather than our service.

Some medical conditions can make your skin condition too complex for us to manage online and you should see a doctor in person. Select all that apply to you. (check one ore more

Dark spots can sometimes be caused by certain medicines. Do you take any of the following medicines?

Do you have any drug allergies?

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

Include vitamins, herbs, and over-the-counter products, like pain relievers and sleep aids and WHY you are taking them.

Anything else you would like us to know?

How would you like to pay?

Billing and delivery details

Personal Details

Confirm Request and Agree to Terms