♂ Patient - Acne Treatment

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What is your birth sex? *

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

Who first diagnosed you with acne? *

What treatment are you currently taking for your acne? *

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

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

What area of your body is affected? *

Are you currently pregnant, actively trying for a baby or breastfeeding? (Females only) *