Where is your acne located?

Tick all areas that apply.

How long have you had acne?

Have you tried any acne treatments before?

This includes over-the-counter products, prescription creams, or oral antibiotics.

Are you pregnant, breastfeeding, or trying to conceive?

Several acne treatments (including retinoids such as Differin and Epiduo, and oral antibiotics such as Lymecycline) are not suitable during pregnancy or breastfeeding.

Do you have any allergies to medicines?

In particular to tetracyclines (e.g. doxycycline, lymecycline), clindamycin, benzoyl peroxide, adapalene, azelaic acid, or any other medication.

Do you have any medical conditions we should know about?

Please tell us about any conditions such as eczema, rosacea, kidney or liver problems, inflammatory bowel disease, lupus, or any other ongoing health issue.

Are you currently taking any medications?

Include prescription medicines, over-the-counter products, the contraceptive pill, vitamins and supplements. Type N/A if none.

Do any of the following apply to you?

These can affect whether certain acne treatments are safe for you. Tick all that apply.

Do you have any red flag symptoms?

These may indicate something more serious that needs GP review. Select yes if you have any of: painful cysts or nodules larger than 5mm, severe scarring, sudden severe flare-up, signs of infection (fever, hot or swollen skin), or symptoms of hormonal imbalance (irregular periods, excess facial hair, rapid weight changes).

Declaration and Consent

By agreeing below, I confirm that:

- The information I have provided in this assessment is accurate and complete to the best of my knowledge, and I understand that providing false information may result in my order being cancelled and could have serious health implications.

- I understand that acne treatments can cause side effects, most commonly skin dryness, redness, irritation, peeling and increased sun sensitivity with topical products, and stomach upset or photosensitivity with oral antibiotics. I have read the product information and understand how to use the treatment correctly.

- I understand that if my acne does not improve within 8-12 weeks, worsens significantly, or I experience any severe side effects, I should stop treatment and contact a healthcare professional.

- I consent to my personal and medical information being used by The Care Pharmacy clinical team to assess my suitability for treatment. My information will be kept confidential and used solely for this assessment.