Start your assessment

Step 1 of 6

Before you start.

A licensed clinician will review everything you share. It takes about five minutes; have your phone handy for photos.

How this works. Software organizes your answers and photos into a draft plan. A licensed clinician reviews the draft, can change or reject it, and makes every decision about your care.

Not for emergencies. If you have swelling of the face, lips or tongue, trouble breathing, a rash with fever, blistering or peeling skin, or a rash that is spreading fast, call 911 or go to the nearest emergency room.

Where do you live?

Clinicians can only treat patients in states where they are licensed. Prescriptions ship to this state.

I am 18 or older and I’m completing this for myself.

Step 2 of 6

About you.

Use your legal name; it appears on your prescription label.

Legal first name

Legal last name

Date of birth

Mobile phone

Email

We’ll send updates about your plan here.

Sex assigned at birth

Some medicines carry different risks, so clinicians need this for safety checks.

FemaleMaleIntersex

Step 3 of 6

Your skin.

Pick what bothers you most. You can add anything else below.

Main concern

AcneBreakouts, blackheads, cystsRosacea & rednessFlushing, persistent redness, bumpsDark spots & melasmaMarks, patches, uneven toneEczema & drynessDry, itchy, reactive skinFine lines & textureEarly lines, rough texture, dullnessSomething elseTell us in your own words

How long has it been going on?

Less than 3 months3–12 months1–5 yearsMore than 5 years

How would you describe it today?

MildNoticeable up closeModerateNoticeable in conversationSeverePainful, scarring or spreading

New products usually…

Are fineSting or redden sometimesCause a reaction most times

In your own words, what would you like to change? optional

Step 4 of 6

Health history.

These answers keep your plan safe. Your clinician sees all of them.

Are any of these true for you?

Some skin medicines, including retinoids, aren’t safe during pregnancy.

PregnantBreastfeedingTrying, or planning in the next 12 monthsNone of these

Medications and supplements

Include prescriptions, birth control, vitamins and anything you take regularly.

I don’t take any medications or supplements.

Any allergies to medicines or skin products?

NoYes

How did they go? Any reactions? optional

How often do you wear sunscreen?

Every daySometimesRarely or never

Step 5 of 6

Three photos.

Your clinician compares these with every check-in, so take them the same way each time.

LightFace a window in daylight. No flash.

Bare skinNo makeup, filters or editing.

Clear viewHair back, glasses off.

DistanceArm’s length, whole face in frame.

Your photos

FrontAdd photoLook straight at the camera. Left sideAdd photoTurn your head to the right. Right sideAdd photoTurn your head to the left.

Photos are resized on your device and location data is removed before they’re sent. They are used for your care and are only used to improve our software after being de-identified. Privacy Policy.

Step 6 of 6

Review & consent.

Check your answers, then sign. You can edit any section.

I have read and agree to the Consent to Telehealth.

I consent to PinkBridge collecting and using my health information, including photos, to provide this assessment and my care, as described in the Consumer Health Data Privacy Policy.

I have received the Notice of Privacy Practices and agree to the Terms & Conditions and Privacy Policy.

My answers are accurate and complete, the photos are of me, and I understand software prepares a draft that a licensed clinician reviews before any decision.

Signature · type your full legal name

Before you start.

About you.

Your skin.

Health history.

Three photos.

Review & consent.

A clinician reviews

They may follow up

You decide