Public Pricelist

Public Pricelist

×
Home
What We Treat
About eClinic
Forum
Contact Us

⁰
⁰
Sign in

♀ Patient - Acne Treatment

Page 1 of 2

STEP 1 OF 2

What is your birth sex? *

MALE

FEMALE

Please select which treatment you would like to apply for? *

What treatment are you currently taking for your acne? *

No treatment

Can you tell us more details about your current treatment? (Names of the medications and how long you have been taking them).

What area of your body is affected? *

Face

Face and Shoulders

Face, Shoulders and Back

Face, Shoulders, Back and Chest

If other, please specify:

Why do you think the medication you are requesting will help your acne? *

Already using it

Have used it in the past

Suggested by a doctor

Suggested by a friend

If other, please specify:

Who first diagnosed you with acne? *

GP

Dermatologist

Online doctor

If other, please specify:

Can you tell us why you think this medication will help you? *

Are you currently pregnant, actively trying for a baby or breastfeeding? *

Yes

No

Not applicable - I am a man

A problem has occured

Something went wrong while contacting survey server. Your answers have probably not been recorded. Try refreshing.

Information

About eClinic
Privacy policy
Term & conditions

Quick links

Home
What We Treat
Contact Us

Connect with us

083 3614859

© 2023 eClinic Limited. Registered in Ireland under: 655071 . All Rights Reserved