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Medical Assessment

Have you been previously diagnosed with Rosacea by your doctor?

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For how long have you been suffering from Rosacea?





Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

When was the last time you were reviewed by a doctor about your Rosacea?






Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Which symptoms are you suffering from? Please tick all the symptoms that apply to you.







Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Do you suffer from any other symptoms?

Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Do you suffer from any of the following?

  • kidney or liver problems;
  • heart or blood circulation problems;
  • you have had, or plan to have any laser procedure on your skin;
  • Parkinson’s disease;
  • depression or anxiety;
  • asthma or other respiratory problems;
  • your vision is blurred;
  • your eye is painful;
  • you are sensitive to light;
  • any other problem or condition we should know about;
Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you taking any of the following?

  • (MAO) inhibitors (selegiline, moclobemide);
  • antidepressants (imipramine, mirtazapin) ;
  • digoxin;
  • blood pressure lowering medication;
Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you taking any other medication not mentioned above (including over the counter medication, herbal medication or recreational drugs)?

Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you allergic to azelaic acid, brimonidine, ivermectine or to any of the ingredients in rosacea treatment?

Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Are you pregnant or breastfeeding or likely to become pregnant or start breastfeeding while taking this medication?

Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Do you have any other skin problems such as eczema, perioral dermatitis or cutaneous epithelioma?

Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Do you agree to the following?

  • You answered truthfully to all the questions and you are aware that any incorrect information you provided might present a danger to your health;
  • You will seek medical attention if you experience any unusual side effects;
  • The treatment is solely for your own use ;
  • You will read the patient information leaflet supplied with your medication;
Error We are unable to prescribe you this medication.

For further information kindly contact our patient support team:

Phone 0207 867 3932

Email email help@clickpharmacy.co.uk.

Please tick the boxes to confirm the following:

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