Skip to main content
search

Virtual Consult Questionnaire

Virtual Consult Questionnaire

By Dr Davin Lim

Thank you for your inquiry. Please fill out the form below so we can understand more about your skin concerns and goals.

This field is hidden when viewing the form

Next Steps: Install the Survey Add-On

This form requires the Gravity Forms Survey Add-On. Important: Delete this tip before you publish the form.

VIRTUAL CONSULT QUESTIONNAIRE

Name(Required)
What is your primary concern?(Required)

* Acne consultations: The aim of this consultation is to provide you with a strategic management plan for your skin. I do not prescribe medication for acne as my work is entirely procedural. Medications such as the oral contraceptive pill, anti-hormonal medications & isotretinoin all require close monitoring. A medical dermatologist can assist in prescriptive medicine.
How long have you had this problem?(Required)
Have you had treatment for this problem before?(Required)
Are you currently using any topicals or oral medication on your skin (gels, creams, serums, lotions, tablets, herbs etc...)?(Required)

PHOTO REQUIREMENTS

Photos are crucial to ascertain a diagnosis. The clearer the better. Please provide a series of between 5 to 8 photos in good lighting.

Here is a super quick 2 minute video that shows you how to take clinically sound photos.

Many thanks for taking the time to complete this questionnaire. The more information you can provide the better I can understand how to formulate a treatment plan for you.

For record keeping purposes, you may record the consultation from your end. This may assist you in recalling the points discussed. Additionally I will provide you with written recommen- dations during the consultation. This will be sent to you in real time.

Disclaimer: a virtual consultation is a compromise that bridges the gap between no consul- tation & a real time consultation. The accuracy of a diagnosis depends largely upon photo- graphs, however some aspects of skin are difficult to capture on static photographs. Examples include shadowing of contours, reflectance of light, ability to visualize redness, & 3D spatial concerns. Dr Davin Lim.

Drop files here or
Accepted file types: jpg, jpeg, png, pdf, heic, Max. file size: 50 MB, Max. files: 20.

    PAYMENT DETAILS

    Option 1) Direct Deposit

    1) Direct Deposit - Please send screen shot if option 1.

    Account Name: Cutis Clinic

    BSB: 084-801

    Account number: 984-160-823

    Reference: PATIENT FULL NAME

    Max. file size: 50 MB.
    Deposit Screenshot

    Option 2) Credit Card (Please note we do not accept AMEX)

    Visa / Mastercard
    This field is for validation purposes and should be left unchanged.

    Latest news

    rejuran for acne scars

    Rejuran S for Acne Scars: Everything You Need to Know

    | Uncategorized | No Comments
    Rejuran for Acne Scars: Everything You Need to Know Key points:  Rejuran is a biostimulator made from polynucleotides (PN)—these are DNA fragments derived from salmon. Rejuran promotes skin regeneration, improves…
    sun damage

    Sun Damage Solutions: Effective Treatments and Prevention

    | Uncategorized | No Comments
    Living in sunny regions like Brisbane, the Gold Coast, and the Sunshine Coast undoubtedly comes with its perks, but it also brings an increased risk of sun damage. The intense…
    antiwrinkleinjectionsBA1 img

    10 Tips to prolong your results from anti-aging procedures

    | Anti-aging, Skin Care, Uncategorized | No Comments
    What skin care is best to maintain anti-aging results? It depends on your goals. It is important to integrate skin care in a timely manner- too soon & skin irritation…
    fraxel laser brisbane, Deep Laser Resurfacing,

    Deep Laser Resurfacing

    | Skin Care, Uncategorized | No Comments
    Deep Laser Resurfacing: Transforming Skin Texture Embark on a journey to enhance your skin's texture through our deep laser resurfacing procedure. Employing a blend of ablative erbium and CO2 lasers,…