Custom Tailored Online Prescription Skincare Solutions

100% Discreet

No Insurance Required

No Photo ID Required

What is your primary skin concern?

Please provide details below. *

What is your current skincare routine?

Please provide skincare routine details below. *

Are you using any prescription skincare medications?

Are you using any prescription skincare medications? *

Do you have any known allergies to skincare products?

Do you have any known allergies to skincare products? *

Have you experienced any recent changes in your skin (e.g., rashes, discoloration)?

Have you experienced any recent changes in your skin (e.g., rashes, discoloration)? *

Do you have a history of skin conditions (e.g., eczema, psoriasis)?

Do you have a history of skin conditions (e.g., eczema, psoriasis)? *

How sensitive is your skin to the sun or skincare products?

How sensitive is your skin to the sun or skincare products? *

Have you had any cosmetic procedures recently (e.g., Botox, chemical peels)?

Have you had any cosmetic procedures recently (e.g., Botox, chemical peels)? *

Do you smoke or consume alcohol?

Do you smoke or consume alcohol? *

What is your daily sun exposure, and do you use sunscreen regularly?

What is your daily sun exposure, and do you use sunscreen regularly? *

Do you experience frequent stress or hormonal changes?

Do you experience frequent stress or hormonal changes? *

Are you currently pregnant or breastfeeding?

Are you currently pregnant or breastfeeding? *

Do you have any family history of skin cancer or severe skin conditions?

Do you have any family history of skin cancer or severe skin conditions? *

Are you taking any medications that might affect your skin?

Are you taking any medications that might affect your skin? *

How much water do you drink daily?

How much water do you drink daily? *

Have you noticed any changes in moles or freckles?

Have you noticed any changes in moles or freckles? *

Do you have any dietary restrictions or allergies?

Do you have any dietary restrictions or allergies? *

What is your age range?

What is your age range? *

Do you use makeup regularly?

Do you use makeup regularly? *

How would you describe your skin type (e.g., oily, dry, combination)?

How would you describe your skin type (e.g., oily, dry, combination)? *

Let's start with the basics

This information helps your doctor determine if you’re eligible for treatment.

First Name *

Email *

Phone *

Date of birth *

Postal code *

I agree to terms & conditions provided by REMI MEDICAL LLC. By providing my phone number, I agree to receive text messages from the business. Your data is 100% secure under HIPAA compliance law. Only your doctor can see this data.