• Virtual Consultation for Acne

    Simply fill out this form to get started!
  • Personal Information:
  • Format: (000) 000-0000.
  • Questions and Details:
  • How would you describe your skin?*
  • Describe your acne, check all that apply*
  • How often do you have the forms of acne listed above?*
  • How sensitive is your skin?*
  • Accutane history*
  • Are you currently using retinol, Retin-A, tretinoin, Renova, Differin, or any other similar product?*
  • Are you currently taking any hormone-based medications such as birth control, hormone replacement therapy, pellets, IUDs, etc.*
  • In the last year have you stopped, started, or changed any hormone-based medications such as birth control, hormone replacement therapy, pellets, IUDs, etc.*
  • How many servings of dairy (milk, cheese, yogurt, whey protein, etc.) do you consume?*
  • Are you taking a B Complex supplement, biotin supplement, or hair/skin/nails supplement?
  • Are you pregnant?*

  • ***Please let us know if you become at any point as we will have to adjust what products you can safely use.***

  • Are you breastfeeding?*
  • Do you use fabric softener, dryer sheets, or scent beads (ex Downy Unstoppables)?*
  • Have you ever had chemotherapy or radiation?*
  • If you are local to the Morgan City area and/or are able to come to our office, would you like recommendations on services that would help you achieve your goals?
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  • We strongly recommend going over your recommendations by either phone call or video call; however, this is not required. How would you like to receive your recommendations?*
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