Global Health

Dados do paciente

Nome completo do pacienteEmailTelefone

Data de nascimento

Enter a date up to 21/10/2026.

PPS number (opcional)

Necessário em documentos médicos no seu país. Pode preencher depois no seu perfil.

Farmácia preferida (opcional)

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IE · Acne · Full

This form is for ongoing facial or body acne. Please upload a clear, well-lit photo of the affected area — this is required for the doctor to assess severity and choose the right treatment. Severe or scarring acne, or acne that hasn't responded to previous treatment, is usually better managed by a dermatologist and may be redirected to a video consultation or referral rather than treated through this form.

About your acne

Please upload a clear, well-lit photo of the affected area

How long have you had this acne, and where is it (face, back, chest, more than one area)?

What treatments have you already tried for this? (select all that apply)

Nothing yetOver-the-counter products (benzoyl peroxide, salicylic acid, etc.)Prescribed topical treatment (cream/gel)Prescribed oral antibioticPrescribed oral isotretinoin (Roaccutane)Prescribed hormonal treatment (contraceptive pill for acne)

Does the acne leave scarring, dark marks, or pitting once it clears?

How is the acne affecting you day to day?

Your health

Could you be pregnant, are you trying to conceive, or are you breastfeeding?

Are you using, or planning to use, hormonal contraception?

Any known allergy to tetracycline antibiotics (e.g. doxycycline, lymecycline) or to clindamycin?

Do you have lupus (SLE), or any autoimmune condition?

Are you currently taking any vitamin A supplements, or any other retinoid/acne medication not already mentioned?

Do you have irregular or infrequent periods, excess facial/body hair growth, or significant recent weight gain alongside the acne?

Do you have plans for significant sun exposure (e.g. holiday, outdoor work) in the near future?

Morada do paciente

Necessária para documentos médicos e materiais físicos.

MoradaApartamento / unidade (opcional)CidadeEircode (optional)

Consentimento de partilha de dados (RGPD)

Confirmo que os dados acima são precisos e consinto numa videoconsulta com o clínico selecionado.Consinto que os meus dados pessoais e médicos sejam processados pela Global Health e partilhados com as suas clínicas tratantes e rede médica — incluindo clínicas noutros países — para efeitos de cuidados, melhoria do serviço e segurança. Política de PrivacidadeQuero receber atualizações da consulta por WhatsApp (opcional)

Acne Treatment

Acne Treatment

About your acne

Your health