Rosacea consultation

Rosacea Consultation

Patient details

Please complete the consultation as accurately as possible.

Are you completing the consultation for yourself?
Is the shipping address the same as above?
Have you been diagnosed this condition by a GP or dermatologist?
How would you describe your rosacea?
Have you tried any products to treat your rosacea?
Which treatments have you tried?
What are the triggers?
Any family history of Rosacea?
Any family history of Lupus?
Do you have any other medical conditions, including skin conditions?
Are you taking any other prescription-only medicines, over-the-counter medicines, alternative medicines or recreational drugs?
Do you have any known allergies?
Do you have any conditions affecting your liver or kidney?
Are you currently pregnant or breastfeeding, or planning to have baby?
Are you currently registered with a UK GP practice?

Photo upload

Please upload at least 2 photos of affected areas - one close-up and the other from distance.

Caution:
Please do not upload photos of private parts.

By uploading photographs you are consenting to store your photos securely in your medical records.  

Consent