Virtual Consult Questionnaire

 

BY DR DAVIN LIM

Thank you for your inquiry. Please fill out the form below so we can understand more about your skin concerns and goals.

VIRTUAL CONSULT QUESTIONNAIRE

Name(Required)
What is your primary concern?(Required)
* Acne consultations: The aim of this consultation is to provide you with a strategic management plan for your skin. I do not prescribe medication for acne as my work is entirely procedural. Medications such as the oral contraceptive pill, anti-hormonal medications & isotretinoin all require close monitoring. A medical dermatologist can assist in prescriptive medicine.

How long have you had this problem?(Required)
Have you had treatment for this problem before?
Are you currently using any topicals or oral medication on your skin (gels, creams, serums, lotions, tablets, herbs etc...)?

PHOTO REQUIREMENTS

Photos are crucial to ascertain a diagnosis. The clearer the better. Please provide a series of between 5 to 8 photos in good lighting.

Accepted file types: jpg, jpeg, png, pdf, heic, Max. file size: 128 MB.

PAYMENT DETAILS

Option 1) Direct Deposit

1) Direct Deposit - Please send screen shot if option 1.

Account Name: Cutis Clinic

BSB: 084-801

Account number: 984-160-823

Reference: PATIENT FULL NAME

Deposit Screenshot
Max. file size: 128 MB.

Option 2) Credit Card (Please note we do not accept AMEX)

Visa / Mastercard
This field is for validation purposes and should be left unchanged.