Do you have mild or moderate acne?

Are you using any other treatments for acne?

Are you taking oral antibiotics?

Do you understand that it can take 4-8 weeks of treatment before beneficial effects are seen?

Do you understand if your acne gets worse or starts to cause scarring, you must see your GP?

Do you understand some topical acne treatments can make your skin more sensitive to sunlight (photosensitivity)? You should avoid sunlight and sunlamps while using topical acne treatments and take care to use sunscreen and cover in protective clothing if sunlight exposure is unavoidable. Do not apply acne products to sunburn

Do you understand that you should use your treatment once a day, after washing your face with a mild cleanser and fully drying?

Do you understand that this medicine must not come in contact with eyes, mouth, mucus membranes, or eczematous/ broken/ sunburned skin, and that if it does by accident you should seek medical advice?

Do you understand that most people will experience some skin redness and peeling during the first few weeks of treatment? If your skin becomes irritated, you may need to use an oil-free moisturiser, use your treatment less often, or stop using it for a short period to allow your skin to recover and then re-start treatment. If irritation persists or symptoms are severe, stop using the medication and contact our help desk or your GP.

Do you agree to the following?

You will read the patient information leaflet supplied with your medication You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment. The treatment is solely for your own use You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.

Are you female and between 18 and 55?

Are you allergic to any of the following:

Adapalene Azelaic Acid Benzoyl Peroxide Clindamycin Tretinoin Propylene Glycol

Are you pregnant, planning on becoming pregnant, or breastfeeding?

Do you have inflammatory bowel disease, eg ulcerative colitis, crohns disease, or any other form of colitis?