GET STARTED

Please complete this brief form to Get Started with quick easy virtual acne and skin care treatment. A dedicated agent will contact you by Email.

First Name *

Last Name

Email Address *

Phone Number *

What Issue Do You Want To Address Today

Age *

how long have you had the symptoms? *

Are you pregnant *YesNo

Please List: *

Are you currently taking any medication *YesNo

Please List: *

Are you taking any vitamins or other supplements or antibiotics *YesNo

Please List: *

Do you have allergies *YesNo

Please List: *

Answer Yes if you would like Audio/Video Consultation with a Doctor (Requires Prepaid 30,000 Naira fee prior to the consultation) *YesNo

Please upload pictures of the area of concern (try to take clear pictures and from different angles).

Upload file *

Drag and Drop (or) Choose Files