How old are you?
14 - 1819 - 2526 - 3333+
What is your sex?
MaleFemale
How long have you had acne?
3 months -1 year1 - 2 years3 - 5 years6 + yearsI don't have acne
What are your skin concerns?
Sporadic bumpsFew bumps but stuborn, stay for longer timeMild or Moderate AcneSevere or Cystic acne (large, red, tender bumps)Rough texture with small white bumps underneath ( visible when you stretch skin)Whiteheads/Closed Comedones (non-sore, non-inflammatory, clogged bumps under the skin)BlackheadsOily SkinLarge poresDiscoloration/ Brown SpotsRed discoloration after clearing blemishesEasily irritated by products/sensitive skinScarsBack or chest acneMore breakouts before cycle
Did you use any of these prescription acne products?
Benzoyl peroxideRetinoids (Tazorac, Epiduo, Avage etcTopical antibiotics ( Benzaclin, Duac, Acanya, Benzamycin etc)Oral Antibiotics (Minocycline, Doxycycline etcIsotretinoin (Accutane)Oral contraceptives (Ortho Tri-Cyclen, Yaz, others)SpironolactoneNone of the above
Did you use any chemical peels in your acne treatment like glycolic acid or salicylic acid? Which ones and which strength? Any allergies, irritations or redness after using them?

Did you get any of these professional treatments?
Acne facialAcne ExtractionsLaser TreatmentsChemical PeelsCortizone injectionsNone of above

Is there anything else you would like to tell me?

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