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OnlineDoc Treatment
Acne Treatment
Only
€
23 per Script
To play, press and hold the enter key. To stop, release the enter key.
Acne Treatment
First Name
Last Name
Date Of Birth
Email
Phone Number
Address
Please specify your gender:
*
Male
Female
Which treatment you are currently using for your acne?
*
No treatment
Please specify below the name and duration of medication which you have been using for acne.
Please Specify Here
Please specify the area of your body which is affected by acne?
*
Face
Face and Shoulders
Face, Shoulders and Back
Face, Shoulders, Back and Chest
Other (please specify)
If Others, Please specify:
Please upload a photo of your current Acne (Optional)
Upload File
Upload supported file (Max 15MB)
If you are currently on any Acne medicines, is your Acne well-controled?
*
Yes
No
Do you have any underlying liver or kidney disease, Epilepsy or other significant past medical history?
*
No
Yes
If Yes, Please specify:
Do you have a significant past medical or surgical history?
*
No
Yes
If Yes, Please specify:
Are you allergic to any medication or any other substance?
*
No
Yes
If Yes, Please specify:
Please provide the name and address of the pharmacy where you'd like to pick up your medications.
I confirm that the answers I have provided for the above questions are true and accurate to the best of my knowledge.
*
I Confirm
I Do Not Confirm
I confirm and agree that any treatment prescribed for me is for my personal use only.
*
I Confirm
I Do Not Confirm
I fully understand the side-effects of the treatment options, their effectiveness and alternative options and am happy to continue with my request.
*
I Confirm
I Do Not Confirm
Proceed to Checkout
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