• Skin & Acne Treatment Intake

  • Welcome to Simone RX Personalized skin care designed to support healthier, clearer, and more confident skin — healing life one day at a time. At Simone RX, we provide convenient provider-led virtual care for common non-urgent skin concerns through a streamlined telehealth experience designed around comfort, accessibility, and personalized treatment support. Our virtual skin services may help address concerns such as acne, dark spots, eczema, folliculitis, hidradenitis suppurativa (HS), razor bumps, hyperpigmentation, and other common skin conditions that can often be managed remotely. Most intakes take approximately 5–7 minutes. ✔ Personalized provider-led skin care ✔ Acne & medication refill support ✔ Convenient virtual treatment options ✔ Secure photo upload for clinical review
  • Important Skin Care Notice

    Conditions Not Appropriate for Virtual Treatment

    Simone RX does not evaluate or treat:
    • suspicious skin growths
    • possible skin cancers
    • rapidly changing moles
    • severe infections
    • large open wounds
    • emergency skin conditions

    If you have:
    • bleeding lesions
    • suspicious or changing moles
    • severe swelling
    • rapidly worsening rash
    • fever with skin symptoms
    • or concerns for skin cancer

    please seek in-person medical or dermatology evaluation promptly.
  • Format: (000) 000-0000.
  • Preferred Communication*
  • What Skin Concern Would You Like Help With Today? (Check all that apply)*
  • Which Areas Are Affected? (Check all that apply)*
  • How Long Have You Been Experiencing This Concern?*
  • Are You Experiencing Any of the Following? (Check all that apply)*
  • Has this condition recently worsened?*
  • Have You Previously Tried Any Treatments? (Check all that apply)*
  • Are You Requesting A Medication Refill?*
  • Do You Have Any Of The Following? (Check all that apply)*
  • Medication Allergies*
  • Photo Upload Guidance Recommended: natural lighting, close-up photo, wider photo showing affected area. Accepted formats: PNG, JPG. Max 10MB per file.
  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof
  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof
  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof
  • Would You Like to Schedule a Virtual Visit With Simone RX?*
  • Format: (000) 000-0000.
  • Consent & Acknowledgment
  • I acknowledge each of the following statements*
  • Thank You for Your Interest

    Simone RX currently serves patients in Georgia, California, and New Hampshire. We've recorded your interest and will reach out when we expand to your state.

    For urgent skin concerns, please seek in-person medical or dermatology evaluation promptly.
  • We've Received Your Information
  • Should be Empty: