Rosacea Consultation Form

    Have you been diagnosed with rosacea by a healthcare professional?

    YesNo

    We recommend getting a diagnosis from a healthcare professional before ordering treatment. You can discuss this with your GP or book for a consultation with one of our specialists clicking here

    How long have you suffered with Rosacea?

    Are you pregnant, breast feeding or trying to conceive?

    YesNo

    Unfortunately we are unable to advise a treatment for you- If you have any questions about this consultation then please contact us on-support@digiderm.co.uk

    What areas of your body are affected by rosacea?

    Have you recently used steroid creams or ointments on your face? Examples of these include: hydrocortisone, Betnovate (betamethasone), Eumovate (clobetasone), etc)

    YesNo

    Please tell us what you used and for how long?

    Do you suffer from any other skin conditions?

    YesNo

    Please tell us about your other skin conditions and any treatment you use for these?

    Do you agree with the following?

    • You agree with our terms and conditions and privacy policy. (Terms & Conditions | Privacy Policy)

    • You will read the patient information leaflet supplied with the medication we send you.

    • This treatment is to be used only by you.

    • The answers provided to the above questions are true and accurate.

    YesNo